Copenhagen, Denmark

ESTRO 2022

Session Item

Poster (digital)
The treatment strategy for cervical cancer; image-guided HDR-ICBT and IMRT using central shielding
Yuki Mukai, Japan


The treatment strategy for cervical cancer; image-guided HDR-ICBT and IMRT using central shielding

Yuki Mukai1

1University Graduate School of Medicine, Radiation Oncology, Yokohama, Japan

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Purpose or Objective

We previously reported the importance of combination therapy of standard external beam radiation therapy that combines whole pelvic radiation therapy (WPRT) and sequential WPRT with central shielding (WPRT-CS) and high-dose-rate intra-cavity brachytherapy (HDR-ICBT).

Recently, we introduced 3D image-guided HDR-ICBT. This study aims to evaluate the treatment outcome and toxicities of the combination therapy of EBRT using IMRT/TomoTherapy, including WPRT and WPRT-CS and image-guided HDR-ICBT.

Material and Methods

We included 52 consecutive patients treated for non-metastatic uterine cervical cancer from August 2011 to April 2021 in this retrospective analysis.

The median age of patients was 64 (range, 30-90) years old, and the performance status (PS) was as follows; PS0: 41, PS1: 10, PS2: 2. All patients had a histopathological diagnosis of uterine cervical cancer, and 46 patients had squamous cell carcinoma (SCC), and the remaining 6 had adenocarcinoma. Primary tumor stages (FIGO) were distributed as follows: IB: 6, IIA: 5, IIB: 12, IIIB: 3, IIIC1:19, IIIC2:4 (with Para-aortic lymph node metastasis), and IVB: 2.

The median dose of WPRT and WPRT-CS was 36 (range, 22–43.2) and 14.4 (range, 9–28) Gy, respectively. Median HDR-ICBT dose/fractions to Point A was 24Gy/5 Fr (range, 15–30 Gy/3–6Fr).

Only one patient developed multiple lung metastases during radiation therapy and terminated local treatment. She was excluded from this analysis.


The median follow-up time was 62.5 (range 2-122) months.

The three and 5-year overall survival (OS), progression-free survival (PFS), and local control of primary tumor (LC) rates were 90.8% and 87.4 % in OS, 89.61% in PFS, and 96% in LC, respectively.

Chemotherapy given concomitantly with RT consisted of weekly cisplatin administration (40 mg/m2 of the body surface area) and was assigned to 41 of the 51 patients (82 %) in 2–6 courses, with a median of 5 courses.

Nine of 51 patients received image-guided HDR-ICBT. The median D2cc values for the rectum, bladder (α/β =10 for EBRT plus HDR-BT) are 80.6 and 71.4 Gy EQD2, respectively.

All acute toxicities were tolerable/manageable, and no patient had ≥ Grade 3 gastrointestinal and genitourinary acute and late toxicities


This study demonstrated an excellent LC rate and favorable OS and PFS. Further studies are needed to confirm the treatment to determine the long-term efficacy and late toxicity.