Session Item

Cervical cancer is common in developing countries, the standard treatment for locally advanced stages is concomitant radiochemotherapy (CRC) followed by uterovaginal (UV) brachytherapy.

The objective of our study is to evaluate toxicities and local control (LC) after planned brachytherapy on a computed tomography (CT) imaging.

This is a retrospective study of all patients irradiated for locally advanced cervical cancer and who received additional UV brachytherapy, within the radiotherapy department of the Mohammed VI university hospital in Tangier, on a period of 5 years between April 2017 and April 2022.

For brachytherapy planning, we used a Fletcher applicator. After placing the applicator, a CT imaging is performed which will be used to contour the target volumes and organs at risk (OAR).

Among 104 patients followed in our department for cervical cancer, 63 patients had received CRC followed by UV brachytherapy. The average age is 54 years (30-80). At diagnosis, 53.9% of patients were classified as stage II, stages III and VIa representing 38% and 8% respectively.

For external radiotherapy, the three dimensional (3D) conformal radiation therapy was used in all patients. Regarding the dose, 92% of the patients had received 46 Gray (Gy) in 23 fractions. Concomitant chemotherapy was based on cisplatin in 93.6% of cases with an average of 5 weekly cycles. For brachytherapy, the schedule of 4 sessions of 7 Gy was used in 88.88% of our patients. The spread of the whole treatment on average is 59 days.

Analysis of the dose-volume histograms (DVH) showed that 2cc of the bladder and 2cc of the rectum had received 91.2 Gy and 78Gy respectively, the bladder constraint was respected in 74.6% of the patients and the rectum constraint was respected in 53.9% of patients. For the coverage of target volumes, D90 of high-risk clinical target volume (HR-CTV) and D90 of Intermediate Risk clinical target volume (IR-CTV) were respectively 79.7 Gy and 67.75 Gy in EQD2, the objectives were achieved in 77% of patients.

Concerning the tolerance of radiotherapy, acute toxicities were dominated by enteritis and cystitis which presented respectively 41% (67.5% of grade II) and 29.5% (78% of grade II), no grade IV toxicity was detected. For chronic toxicities, the most common were radiation proctitis, cystitis and vaginal synechia found in 63% (65% grade II), 27% (71% grade II) and 27% (76% grade II) cases respectively. After an average follow-up of 38 months, relapses are around 9.5%, including 7.9% of local recurrences.

By comparing our results with those of the literature, we noted more toxicities in our patients, in particular radiation proctitis, this can be explained by the overestimation of volumes with the CT imaging, the use of the 3D conformal radiation therapy and the frequency of locally advanced stages. On the other hand, the LC rate agrees with the data in the literature.