MRI-guided adaptive brachytherapy after chemoradiotherapy resulted in long-term local control in patients with cervical cancer, according to results of the EMBRACE-I study published in The Lancet Oncology.
“These results represent a positive breakthrough in the treatment of locally advanced cervical cancer, which might be used as a benchmark for clinical practice and all future studies,” the authors stated.
The EMBRACE-I study (ClinicalTrial.gov Identifier: NCT00920920) was the first large, prospective study of the use of MRI-based image-guided adaptive brachytherapy (IGABT) for patients with locally advanced cervical cancer, with an aim to determine clinical outcomes associated with this treatment.
The study included data from 1251 patients with International Federation of Gynecology and Obstetrics (FIGO) stage IB-IVB disease accrued from 2008 to 2015.
Patients with stage IVB cervical cancer had disease restricted to para-aortic lymph nodes below the L1-L2 interspace, and all patients were eligible for curative treatment.
Patients received chemoradiotherapy followed by MRI-based IGABT. Dose optimization of IGABT was performed in 98.2% of patients, and the high-risk clinical target volume was a median of 28 cm3. The median minimal dose to 90% of the clinical target volume was 90 Gy equi-effective dose in 2 Gy per fraction.
The median follow-up was 51 months. At 5 years, 92% of patients achieved the primary endpoint of actuarial overall local control.
Rates of pelvic and nodal control were both 87% at 5 years. There was no difference in local control across FIGO stages.
At 5 years, the overall survival rate was 74%, and the disease-free survival rate was 68%.
Rates of grade 3 to 5 adverse events were low, with a cumulative incidence of 8.5% for gastrointestinal events, 6.8% for genitourinary events, 5.7% for vaginal events, and 3.2% for fistula.
“Chemoradiotherapy and MRI-based IGABT result in effective and stable long-term local control across all stages of locally advanced cervical cancer, with a limited severe morbidity per organ,” the study authors concluded.
Disclosures: This research was supported by Elekta AB, Varian Medical Systems, the Medical University of Vienna, and Aarhus University Hospital. Several study authors declared affiliations with the radiotherapy industry. Please see the original reference for a full list of authors’ disclosures.
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;22(4):538-547. doi:10.1016/S1470-2045(20)30753-1