Abstract

Florent GUILLEMIN¹, Pascal POMMIER², Anne-Agathe SERRE², Frédéric GASSA², Nathalie SANDT², Frédéric LAFAY²

¹Centre Jean Perrin, Radiotherapy, Clermont-Ferrand, France; ²Centre Léon Bérard, Radiotherapy, Lyon, France

According to the European guidelines for cervix cancers, management of cervical stump cancers should follow the recommendations of patients without previous subtotal hysterectomy, but may necessitate an adaptation of the radiotherapy modalities especially for brachytherapy (BT). However, data with modern BT technics are very scarce.

From May 2013 to March 2020, 6 patients (71 to 88 years) with cervical stump squamous cell carcinoma have been treated by external beam radiotherapy (IMRT, 45Gy in 25 fractions (5 patients) and 50,4Gy in 28 fractions (1 patient)) with concomitant chemotherapy in 2 patients, followed by Image Guided adaptive brachytherapy with Pulsed Dose Rate (5 patients) or High Dose Rate (1 patient).

We used the Utrecht Interstitial BT applicator (ELEKTA), with the implant of bilateral (3 patients) or unilateral (3 patients) external interstitial needles and the insertion of the four interstitial internal needles within the residual cervix (3 patients). Dosimetry was based on the GEC-ESTRO recommendations.

The median HR-CTV volume was 15.15cc (12-35cc). The median dose delivered to 90% (D90) of the High-Risk and Intermediate Risk CTV was 81.2 (78.2- 89.8) and 68,95 (64.3-72.3) GyEQD2 respectively. With a 26,5 months median follow-up (10-92 months), we did not observe any local or distant recurrence. No grade 2 or more acute or late toxicities were reported.

Cervix brachytherapy with a standard applicator using interstitial needle is safe and effective in cervical stump cancer patients.