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Session Item

Sunday

August 29

10:30 - 11:30

Room 1

Proffered papers 17: Gynaecological

Chair: , Italy;

Chair: , The Netherlands

Session Code: 1060

Session Type: Proffered papers

Track: Clinical

10:30 - 10:40

New Prognostic factors in locally advanced cervical cancer treated with MR-IGABT in EMBRACE Study.

Umesh Mahantshetty, India

Presentation Number: OC-0295

Abstract

Abstract Title:

New Prognostic factors in locally advanced cervical cancer treated with MR-IGABT in EMBRACE Study.

Authors:

UMESH MAHANTSHETTY¹, Maximilian Schmid², Christian Kirisits³, Kari Tanderup⁴, Christine Haie-Meder⁵, Lars Fokdal⁶, Alina Sturdza⁷, Peter Hoskin⁸, Barbara Segredin⁹, Kjersti Bruheim¹⁰, Fleur Huang¹¹, Bhavana Rai¹², Rachel Cooper¹³, Elzbieta van der Steen-Banasik¹⁴, Erik van Limbergen¹⁵, Bradley Pieters¹⁶, Li Tee Tan¹⁷, Rohini Hawaldar¹⁸, Sadhana Kannan¹⁹, Remi Nout²⁰, Astrid A.C. de Leeuw²¹, Nicole Nesvacil²², Ina Jürgenliemk-Schulz²³, Jacob Lindegaard²⁴, Richard Pötter ²²

¹Tata Memorial Hospital, (Homi Bhabha Caner Hospital & Research Centre, Visakhapatnam), , Radiation Oncology , Vishakhapatnam, India; ²Medical University of Vienna, Comprehensive Cancer Center, Department of Radiation Oncology-, Vienna, Austria; ³Medical University of Vienna, Comprehensive Cancer Center, Department of Radiation Oncology, Vienna, Austria; ⁴Aarhus University Hospital , Department of Oncology, Aarhus, Denmark; ⁵Institute Gustave-Roussy , Department of Radiotherapy, Villejuif, France; ⁶Aarhus University Hospital, Department of Oncology, Aarhus, Denmark; ⁷Medical University of Vienna, Comprehensive Cancer Center,, Department of Radiation Oncology, Vienna, Austria; ⁸Mount Vernon Hospital, Mount Vernon Cancer Centre , Department of Radiotherapy , Northwood, United Kingdom; ⁹Institute of Oncology Ljubljana, University of Ljubljana, Department of Radiotherapy,, Ljubljana, Slovenia; ¹⁰The Norwegian Radium Hospital- Oslo University Hospital Norway, Department of Oncology, Oslo, Norway; ¹¹Cross Cancer Institute and University of Alberta, Department of Oncology, Edmonton, Canada; ¹²Postgraduate Institute of Medical Education and Research , Department of Radiotherapy and Oncology,, Chandigarh, India; ¹³St James's University Hospital, Leeds Cancer Centre, Department of Radiotherapy , Leeds, United Kingdom; ¹⁴Radiotherapie groep Arnhem, Department of Radiotherapy, Arnhem, The Netherlands; ¹⁵UZ Leuven, Department of Radiation Oncology, Leuven, Belgium; ¹⁶ Amsterdam University Medical Centers, University of Amsterdam, Department of Radiation Oncology,, Amsterdam, The Netherlands; ¹⁷Addenbrooke´s Hospital, Cambridge University Hospitals, Department of Oncology, Cambridge, United Kingdom; ¹⁸Tata Memorial Centre, Department of Clinical Research Secretariat, Mumbai, India; ¹⁹ACTREC, Tata Memorial Centre, Department of Biostatisitcs, Navi Mumbai , India; ²⁰Leiden University Medical Center, Department of Radiation Oncology , Leiden, The Netherlands; ²¹University Medical Centre Utrecht, Department of Radiation Oncology, Utrecht, The Netherlands; ²²Medical University of Vienna, Comprehensive Cancer Center, Department of Radiation Oncology , Vienna, Austria; ²³University Medical Centre Utrecht, , Department of Radiation Oncology , Utrecht, The Netherlands; ²⁴Aarhus University Hospital , Department of Oncology, Aarhus, Denmark

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Purpose or Objective

The aim is to investigate prognostic factors affecting overall disease outcome and survival in patients treated with chemoradiation and MR Image Guided Adaptive Brachytherapy (IGABT) in the prospective observational multi-centre IntErnational study on MRI-guided BRAchytherapy in locally advanced CErvical Cancer (EMBRACE) study.

Material and Methods

Between 2008-2015 a total of 1416 pts with LACC were prospectively enrolled in EMBRACE from 24 centers. Patient, tumor (clinical/ MRI at diagnosis & BT) and treatment related parameters (EBRT, Concomitant chemotherapy and BT details, dose volume parameters, total doses and overall treatment time) were analyzed. Disease Control (DC) was defined as absence of any recurrence or progression, Disease Free Survival (DFS) as absence of any disease event or death from any cause and Overall Survival (OS) as death from any cause, respectively. Kaplan-Meier method were used to estimate survival and Cox proportional regression models were used for multivariate analyses (MVA). Hazard Ratio’s (HR) & 95% Confidence Interval (CI) with a p-value < 0.05 were considered statistically significant. The model was carefully selected to define independent factors related with various patient, tumor and treatment parameters including age, FIGO stage, hemoglobin, clinical & MR tumor parameters, nodal involvement etc.

Results

1341 patients were eligible for analysis. With a median follow up of 51 months, in total 331/ 1318 patients had events and/or deaths for DC, 427/1341 for DFS and 363 / 13 41 for OS. FIGO₂₀₀₉ stage distribution was IB 241 (18%), IIA 67 (5%), IIB 683 (52%), IIIA 13 (1%), IIIB 183 (14%), IVA 34 (3%), IVB_{(para-aortic nodes)} 97 (7%); 52% were node-positive, 82% had squamous Cell Carcinoma. Median (Inter Quartile Range [IQR]) high risk CTV volume was 28 (20, 40) cm3. Median (IQR) D90% was 90 (85, 94) Gy _EQD2.The overall DC, DFS and OS at 5 years was 74%, 68% and 74% respectively. Table 1 shows the hazard ratio (95% CI) and p-value of MVA for DC, DFS and OS. Presence of tumor necrosis at diagnosis, distal parametrial involvement and larger CTV_HR volume at BT showed a significant impact on DC, DFS and OS apart from classical prognostic factors as age, histological type, nodal involvement and OTT. The concordance indices (C-index with 95% CI) were 0.6735 (0.6417 – 0.7053), 0.6872 (0.6586 – 0.7158) and 0.6981 (0.6669 – 0.7292) for DC, DFS and OS respectively.

Conclusion

We report new prognostic factors for disease control and survival in patients treated with IGABT for locally advanced cervical cancers.: tumor necrosis at diagnosis, distal parametrial involvement and larger CTV_HR volumes at brachytherapy. These factors seem to be even more important than the FIGO Stage after chemoradiation and IGABT.