ESTRO 2025 - Abstract Book

S808

Clinical - Gynaecology

ESTRO 2025

1336

Digital Poster Modern chemoradiation followed by radical surgery in patients with locally advanced cervical cancer: the LARA 4 phase II study Rosa Autorino 1 , Gabriella Macchia 2 , Luigi Pedone Anchora 3 , Camilla Certelli 3 , Stefano Restaino 4 , Francesca Titone 5 , Alessia Surgo 6 , Francesco Cosentino 7 , Giuseppe Vizzielli 4 , Francesco Legge 8 , Viola De Luca 1 , Valentina Lancellotta 1 , Giovanni Scambia 3 , Maria Antonietta Gambacorta 1,9 , Gabriella Ferrandina 3 1 Radiotherapy Unit, Institute of Radiology, Department of Radiological, Radiotherapeutic, and Hematological Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy. 2 Radiation Oncology Unit, Responsible Research Hospital, Campobasso, Italy. 3 Gynecologic Oncology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Roma, Italy. 4 Medical Area (DMED), Clinic of Obstetrics and Gynecology Unit, Santa Maria Della Misericordia Hospital, Azienda Sanitaria Friuli Centrale, Udine, Italy. 5 Radiation Oncology Unit, Santa Maria Della Misericordia Hospital, Azienda Sanitaria Friuli Centrale, Udine, Italy. 6 Radiation Oncology Unit, Regional General Hospital 'F. Miulli', Acquaviva, Italy. 7 Department of Gynecologic Oncology, Responsible Research Hospital, Campobasso, Italy. 8 Unit of Obstetrics and Gynecology, Regional General Hospital 'F. Miulli', Acquaviva, Italy. 9 Istituto di Radiologia, Università Cattolica del Sacro Cuore, Roma, Italy Purpose/Objective: Exclusive chemoradiotherapy (CRT) is the treatment of choice for patients with locally advanced cervical cancer (LACC) but radical surgery (RS) after neoadjuvant CRT has been investigated over the years with promising results. Radiotherapy techniques have evolved to improve local disease control and reduce toxicity. However, they have primarily been investigated in exclusive CRT settings. The present study aims to evaluate the efficacy of image guided radiotherapy with simultaneous integrated boost-volumetric modulated arc therapy (VMAT)/IMRT plus concomitant chemotherapy in the preoperative treatment of LACC. Material/Methods: Between March 2021 and April 2023, a consecutive series of LACC patients were accrued at four oncological centers. Patients underwent a neoadjuvant CRT with a dose of 50 Gy at 2 Gy/fraction to the tumor and positive nodes and 45 Gy at 1.8 Gy/fraction to the pelvis in 25 fractions. Plans consisted of two arcs using 10-15-MV photon beams. Results: A total of 109 patients were enrolled. Most of the patients showed a pre-treatment FIGO stage of IIIC1 (72, 66.1%). The majority of patients (90, 82.6%) had a squamous histotype. All the patients completed the neoadjuvant CRT and only 3 cases of radiation-related toxicity of grade 3 were reported. At the end of CRT, 5 (4.6%) patients showed progressive disease, and, therefore, they did not undergo RS after CRT. Thirty-nine (35.8%) patients showed a complete response, 33 (30.3%) macroscopic residual tumors, and 32 (29.4%) microscopic residual disease. Only 2 high-grade postoperative complications, 1 early and 1 late, were recorded (Table 1). With a median follow-up of 30 months (range 9-50), survival analysis showed a 3-year disease-free survival of 78.0% and a 3-year overall survival of 92.0%.