ESTRO 2025 - Abstract Book

S234

Brachytherapy - Gynaecology

ESTRO 2025

Conclusion: This study demonstrates feasibility of centralizing BT for the treatment of locally advanced cervical cancer, in compliance with EMBRACE II guidelines [2]. The outcomes show excellent local and regional control comparable with reference literature [3].

Keywords: Cervical cancer, IC/IS, centralization

References: 1 Cibula D, Raspollini MR, Planchamp F, et al. ESGO/ESTRO/ESP Guidelines for the management of patients with cervical cancer - Update 2023. Int J Gynecol Cancer. 2023 May 1;33(5):649-666. 2 Pötter R, Tanderup K, Kirisits C, et al. The EMBRACE-II study: the outcome and prospect of two decades of evolution within the GEC-ESTRO GYN working group and the EMBRACE studies . Clin Transl Radiat Oncol 2018; 9: 48–60. 3 Pötter R, Tanderup K, Schmid MP et al. MRI-guided adaptive brachytherapy in locally advanced cervical cancer (EMBRACE-I): a multicentre prospective cohort study. Lancet Oncol. 2021 Apr;22(4):538-547.

1625

Digital Poster Electronic brachytherapy in the complex treatment of locally advanced cervical cancer

Desislava Hitova- Topkarova 1,2 , Virginia Payakova 2 , Desislava Kostova- Lefterova 3 , Elitsa Encheva 4 , Nikolay Mutkurov 5 , Ilko Iliev 6 , Marin Valkov 2 , Konstantina Karakadieva 6 , Mirela Ivanova 2 , Angel Yordanov 6 1 Roentgenology and radiotherapy, Medical University- Pleven, Pleven, Bulgaria. 2 Radiation oncology, UMHAT Dr Georgi Stranski, Pleven, Bulgaria. 3 Medical college, Medical University- Pleven, Pleven, Bulgaria. 4 Radiation oncology, UMHAT St Marina, Varna, Bulgaria. 5 Radiation oncology, Complex oncology center Burgas, Burgas, Bulgaria. 6 Gynecologic oncology, Medical University- Pleven, Pleven, Bulgaria Purpose/Objective: An electronic brachytherapy (EBT) unit was equipped for the implementation of cervical brachytherapy due to the high local demand for such a modality and the lack of brachytherapy machines in the region. The purpose of the current study is to report the first dosimetric and clinical results. Material/Methods: 25 patients with a median age of 60 years (range 29 – 83) were treated with VMAT and daily CBCT to a total dose of 45 Gy with concomitant boosts in involved regional lymph nodes of 55 Gy. Concurrent chemotherapy was Cisplatin 40 mg/m 2 weekly. Histology distribution was: keratinizing SCC G2- 7 cases, nonkeratinizing SCC- 13 G2 and 4 G3, and squamotransitional carcinoma- 1. The number of patients according to FIGO 2018 staging was 1 IB3, 1 IIA, 7 IIB, 1 IIIB, 10 IIIC1, 2 IIIC2, and 3 IVA. EBT was delivered with the Elekta Xoft® Axxent® Electronic Brachytherapy (eBx®) System® utilizing a 50-KV X-ray source and Henschke applicators. The prescribed schedule was 4 fractions of 7 Gy to the CTV-HR. After an initial MRI, each session was planned on CT images utilizing BrachyCare version 1.1.0. Toxicity was assessed according to CTCAE version 5. Results: The median EBT treatment time per session of 7 Gy was 13,5 minutes (range 9,1 -23,6). The median value of CTV HR receiving the prescribed dose was 94% (range 88-97), and maximum doses in organs at risk received in 2 cm 3 volume per fraction were: bladder D2cc- 410 cGy (range 239-739), rectum D2cc- 189 cGy (39-801), and sigmoid- 255 cGy (range 104-703). Patients were followed up for a median of 12 months (range 3-18). Three (12%) patients were diagnosed with both persistent disease in the uterine cervix and distant metastases, and two (8%) had nodal persistence during the first three months of follow up. All of them were stage IIIC. No further events of recurrences and progression have been noted. Toxicity among patients without recurrences is presented in Figure 1.