Main Session
Sep
29
PQA 06 - Genitourinary Cancer, Gynecological Cancer, and Health Care Access and Engagement
3739 - Outcomes of a Transrectal Ultrasound-Guided Real-Time Adaptive Brachytherapy Program for Locally Advanced Cervical Cancer: A Prospective Analysis of 61 Consecutive Patients
Presenter(s)
Urvashi Gupta, MD, MBBS - Amrita Institute of Medical Sciences and Research Centre, Faridabad, -1
U. Gupta1, R. Kumar2, B. Vishwanathan2, S. K V1, D. Manigandan3, R. Kamal2, D. Thapar4, R. R. Shinde5, C. Choudhary5, and U. K. Maheshwari5; 1Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Faridabad, -1, India, 2Amrita Institute of Medical Sciences and Research Centre, Faridabad, India, 3Amrita Institute of medical science, FARIDABAD, India, 4Institute of Liver and Biliary Sciences, New Delhi, India, 5Amrita institute of medical sciences, Faridabad, India
Purpose/Objective(s):
Prospective outcome data on transrectal ultrasound (TRUS) guided adaptive brachytherapy for locally advanced cervical cancer (LACC) from resource limited settings remain scarce. We report outcomes from a prospective registry of 61 patients treated with TRUS guided real time brachytherapy with MRI based planning using intracavitary (ICRT), interstitial (ISBT), and hybrid IC/IS techniques. Materials/Methods: Between Jan 2023 to Dec 2025, 61 LACC patients (FIGO IB–IVA) received pelvic EBRT (45–50.4 Gy/25–28 fractions) with weekly cisplatin, followed by HDR brachytherapy. All insertions were performed under real time TRUS guidance; treatment planning was MRI based (90.2%) or CT based (9.8%). Applicators were: Fletcher tandem ovoid (67.2%), Venezia IC/IS (23.0%), MUPIT template (9.8%). Combined IC+ISBT was performed in 29.5%. All IIIC1 patients (29.5%) received nodal boost via SIB (77.8%) or single fraction SBRT (22.2%). Target: cumulative EQD2 HRCTV D90 was = 85 Gy per EMBRACE-II. The Endpoints were: local control (LC), progression free survival (PFS), and overall survival (OS) by Kaplan Meier method and Toxicity as per CTCAE v5.0. Results: Median age was 58 years (range 41–78). FIGO stages: IIB 45.9%, IIIC1 29.5%, IIIB 13.1%. SCC comprised 88.5%. Median tumor volume was 35.8 cc. Concurrent cisplatin was administered in 91.8%, with 83.6% completing =4 cycles. Median EQD2 HRCTV D90 was 87.2 Gy (IQR 83.5–91.8), bladder D2cc 72.1 Gy, rectum 63.4 Gy, sigmoid 58.2 Gy all meeting EMBRACE II criteria.Median OTT was 51 days; 95.1% completed treatment within 56 days. Perforation rate was 1.6% (1/61). Acute grade =3 toxicity occurred in 13.1%, mainly hematologic (neutropenia G3: 8.2%). Late grade =3 toxicity was limited to proctitis (4.9%). At median follow up of 14.2 months (IQR 8.3–22.1), 4 progression, 2 distant mets, 1 in-field nodal recurrence, and 1 residual disease seen. One year LC was 98.4% (95% CI: 91.5–99.7), PFS 93.4% (95% CI: 84.3–97.5), and OS 100%. Conclusion: TRUS guided real time adaptive brachytherapy with MRI based planning achieves excellent LC and PFS with low toxicity in LACC. It enables safe applicator insertion and facilitates combined IC+ISBT, achieving robust EQD2 D90 of 87.2 Gy with favourable OAR doses. The predominance of distant failures (2/4 events) with near-complete local control underscores the efficacy of this approach and highlights the need for systemic therapy intensification in high risk subgroups. This pragmatic, resource-efficient model demonstrates outstanding oncologic outcomes suitable for LMIC replication. Keywords- Carcinoma cervix, TRUS guided brachy, MRI-guided brachytherapy.| Parameter | value | 95%CI |
| EQD2 HR-CTV D90(Gy) | 87.2(83.5-91.8) | |
| OTT=56 days | 58/61(95.1%) | |
| Perforation rate | 1/61(1.6%) | |
| Toxicities | ||
| Acute G=3 | 8/61(13.1%) | |
| Late G=3 | 3/61(4.9%) | |
| Oncological outcomes | ||
| LC | 98.4% | 91.5-99.7% |
| PFS | 93.4% | 84.3-97.5% |
| OS | 100% | |
| Pattern of failure | ||
| Distant metastasis | 2(3.3%) | |
| In field nodal failure | 1(1.6%) | |
| Residual cervix | 1(1.6%) | |
| Total events | 4(6.6%) |