AUTHOR=Lai Ying-Lu , Jin Ye-Ning , Wang Xi , Qi Wei-Xiang , Cai Rong , Xu Hao-Ping 

TITLE=The Case Selection for Vaginal Cuff Brachytherapy in Cervical Cancer Patients After Radical Hysterectomy and External Beam Radiation Therapy

JOURNAL=Frontiers in Oncology

VOLUME=Volume 11 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2021.685972

DOI=10.3389/fonc.2021.685972

ISSN=2234-943X

ABSTRACT=Objective
To Explore the suitable cases for vaginal cuff brachytherapy(VCB) combined with  external beam radiation therapy(EBRT) in the postoperative treatment of cervical cancer.          
Methods
We retrospectively analyzed the clinical data of 214 postoperative cervical cancer patients who received radiotherapy from January 2008 to December 2015. Among them, 146 pa-tients received postoperative EBRT, 68 received EBRT plus VCB. There was no statistical difference in clinical and pathological characteristics between these two groups. Those who with negative vaginal cuff underwent supplemented 12-18Gy/2-3Fx VCB. Survival anal-yses were performed using Kaplan-Meier method, and Cox model was used to analyze prognostic factors.            
Results
The median follow-up was 52 months (9-136 months), and 4-year RFS (recurrence-free survival) was 77%. Among them, 58 patients (27.10%) had local or distant recurrences, 29 (13.55%) in pelvis, 6 (2.80%) with metastases to para-aortic, 19 (8.88%) with distant metas-tases (including inguinal lymph nodes) and 4 (1.87%) with both local and distant recurrenc-es. The postoperative brachytherapy boost did not improve RFS or OS (overall survival) among the investigated subjects, P=0.77, P=0.99, respectively. Neither it decreased the lo-cal relapse in the pelvis or vaginal cuff, P=0.56, P=0.59. Subgroup analyses showed that brachytherapy boost improved RFS in patients who had bulky mass (>4cm)  as well as 1) with deep stromal invasion (>50% stromal invasion), P=0.012 or 2) received low EBRT dose (≤ 45Gy), P=0.033, and in patients with deep stromal invasion as well as received low EBRT dose (P=0.018).             
Conclusions
We first proposed the case selection model for postoperative EBRT plus VCB. Brachy-therapy boost were considered in the setting of postoperative radiotherapy if the patients had at least 2 out of these following factors: bulky mass, deep stromal invasion and low EBRT dose.