Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al] · 2026
The impact of uterine position during brachytherapy on treatment outcomes and toxicity in patients with cervical cancer.
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Yigit Ecem, Gultekin Melis, Bayatfard Pantea, Yuce Sari Sezin, Biltekin Fatih, Yildiz Ferah
Аннотация
PURPOSE: To evaluate the impact of uterine position during brachytherapy on dosimetric parameters, oncologic outcomes, and toxicity in cervical cancer patients treated with external beam radiotherapy (EBRT) followed by high-dose-rate intracavitary brachytherapy (HDR-ICBT).
METHODS: A retrospective analysis was conducted on 278 non-metastatic cervical cancer patients treated between 2012 and 2022. All received 45-50.4 Gy EBRT followed by 28 Gy HDR-ICBT in four fractions. Uterine position was documented for each ICBT fraction, and patients with inter-fraction variations were excluded.
RESULTS: In total, 251 patients met the inclusion criteria: 222 (88%) had an anteverted and 29 (12%) had a retroverted uterus. Median follow-up was 44 months (range: 1-134 months). The 2- and 5‑year overall survival rate was 82% and 71% for an anteverted vs. 77% and 77% for a retroverted uterus (p = 0.8). Local recurrence developed in 21 (10%) and three (11%) patients, respectively (p = 0.89). Median doses to the high- and intermediate-risk clinical target volumes (CTV) were higher with an anteverted uterus (91.3 vs. 89.8 Gy, p = 0.001; and 67.4 vs. 65.9 Gy, p = 0.044). A retroverted uterus was associated with higher rectum (76.3 vs. 79.7 Gy, p = 0.001) and bowel doses (66.4 vs. 73.7 Gy, p = 0.023), yet lower sigmoid doses (63.4 vs. 59.9 Gy, p = 0.005). Severe toxicity rates were similar, although late grade 1-2 gastrointestinal toxicity was more frequent in the retroverted group (4% vs. 17%, p = 0.019).
CONCLUSION: A retroverted uterine position during ICBT was associated with lower CTV doses and higher rectum and bowel doses while oncologic outcomes and severe toxicity remained comparable.
METHODS: A retrospective analysis was conducted on 278 non-metastatic cervical cancer patients treated between 2012 and 2022. All received 45-50.4 Gy EBRT followed by 28 Gy HDR-ICBT in four fractions. Uterine position was documented for each ICBT fraction, and patients with inter-fraction variations were excluded.
RESULTS: In total, 251 patients met the inclusion criteria: 222 (88%) had an anteverted and 29 (12%) had a retroverted uterus. Median follow-up was 44 months (range: 1-134 months). The 2- and 5‑year overall survival rate was 82% and 71% for an anteverted vs. 77% and 77% for a retroverted uterus (p = 0.8). Local recurrence developed in 21 (10%) and three (11%) patients, respectively (p = 0.89). Median doses to the high- and intermediate-risk clinical target volumes (CTV) were higher with an anteverted uterus (91.3 vs. 89.8 Gy, p = 0.001; and 67.4 vs. 65.9 Gy, p = 0.044). A retroverted uterus was associated with higher rectum (76.3 vs. 79.7 Gy, p = 0.001) and bowel doses (66.4 vs. 73.7 Gy, p = 0.023), yet lower sigmoid doses (63.4 vs. 59.9 Gy, p = 0.005). Severe toxicity rates were similar, although late grade 1-2 gastrointestinal toxicity was more frequent in the retroverted group (4% vs. 17%, p = 0.019).
CONCLUSION: A retroverted uterine position during ICBT was associated with lower CTV doses and higher rectum and bowel doses while oncologic outcomes and severe toxicity remained comparable.