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We report an updated analysis of the outcomes and toxicities of MRI-based brachytherapy for locally advanced cervical cancer from a U.S. academic center. A retrospective review was performed on patients treated with MRI-based brachytherapy for cervical cancer. EBRT was standardly 45 Gy in 25 fractions with weekly cisplatin. MRI was performed with the brachytherapy applicator in situ. Dose specification was most commonly 7 Gy for 4 fractions with optimization aim of D90 HR-CTV EQD2 of 85–95 Gy α/β=10 Gy in 2 implants each delivering 2 fractions. Ninety-eight patients were included with median follow up of 24.5 months (IQR 11.9–39.8). Stage IIIA-IVB accounted for 31.6% of cases. Dosimetry results include median GTV D98 of 101.0 Gy (IQR 93.3–118.8) and HR-CTV D90 of 89 Gy (IQR 86.1–90.6). Median D2cc bladder, rectum, sigmoid, and bowel doses were 82.1 Gy (IQR 75.9–88.0), 65.9 Gy (IQR 59.6–71.2), 65.1 Gy (IQR 57.7–69.6), and 55 Gy (IQR 48.9–60.9). Chronic grade 3+ toxicities were seen in the bladder (8.2%), rectosigmoid (4.1%), and vagina (1.0%). Three-year LC, PFS, and OS were estimated to be 84%, 61.7%, and 76.1%, respectively. MRI-based brachytherapy demonstrates excellent local control and acceptable rates of high-grade morbidity. These results are possible in our population with relatively large volume primary tumors and extensive local disease. • Local control, overall survival, and progression-free survival at our institution are similar to larger studies. • Dose planning limits to organs-at-risk were met in a population with a higher proportion of stage IIIA-IVB patients. • Chronic grade 3+ toxicities were seen in 13.3% of patients, mostly in stage IIIB and IVA patients. [ABSTRACT FROM AUTHOR]

Curative-intent radiotherapy for locally advanced and select early stage cervical cancer in the US includes external beam radiotherapy (EBRT) with brachytherapy. Although there are guidelines for brachytherapy dose and fractionation regimens, there are limited data on practice patterns. This study aims to evaluate the contemporary utilization of cervical cancer brachytherapy in the US and its association with patient demographics and facility characteristics. We retrospectively analyzed clinical covariates of cervical cancer patients diagnosed and treated in 2018–2020 with curative-intent radiotherapy from the 2020 National Cancer Database. Associations between patient and institutional factors with the number of brachytherapy fractions were identified with logistic regression. Factors with association (p < 0.10) were then included in a multivariable logistic regression model. All tests were two-sided with significance <0.05 unless specified otherwise. Among the eligible 2517 patients, 97.3% received HDR or LDR and is further analyzed. More patients received HDR than LDR brachytherapy (98.9% vs 1.1%) and intracavitary than interstitial brachytherapy (86.4% vs 13.6%). The most common number of HDR fractions prescribed were 5 (51.0%), 4 (32.9%), and 3 (8.6%). After adjusting for the other variables in the model, ethnicity, private insurance status, overall insurance status, and facility type were the only factors that were significantly associated with the number of brachytherapy factions (p < 0.0001, p = 0.028, p = 0.001, and p < 0.0001, respectively, n = 2184). In the US, various HDR brachytherapy regimens are utilized depending on patient and institutional factors. Future research may optimize cervical cancer brachytherapy by correlating specific dose and fractionation regimens with patient outcomes. • Curative-intent radiotherapy for cervical cancer in the US may include external beam radiotherapy and brachytherapy. • This is the first assessment of physician practice pattern of curative-intent brachytherapy for cervical cancer in the US. • Most patients received HDR intracavitary brachytherapy and completed their radiotherapy as prescribed. • Patient ethnicity, insurance, and facility type are significantly associated with number of HDR brachytherapy fractions. [ABSTRACT FROM AUTHOR]

Uterine serous carcinoma is a rare but aggressive subtype of endometrial adenocarcinoma. Our objective was to compare adjuvant treatment strategies for patients with early stage uterine serous carcinoma. This multi-institutional, retrospective cohort study evaluated patients with early stage uterine serous carcinoma. Patients with FIGO Stage IA-II disease after surgery, whose tumors had serous or any mixed serous/non-serous histology were included. Patients with carcinosarcoma were excluded. Clinical data were abstracted from local medical records. Summary statistics, Fisher's exact, and Kruskal-Wallis tests were used to analyze demographic and clinical characteristics. Univariable and multivariable analyses were performed for recurrence-free and overall survival. There were 737 patients included. Most patients had Stage IA disease (75%), 49% of which had no myometrial invasion. Only 164 (24%) tumors had lymphatic/vascular space invasion. Adjuvant treatment varied: 22% received no adjuvant therapy, 17% had chemotherapy alone, 19% had cuff brachytherapy, 35% had cuff brachytherapy with chemotherapy, and 6% underwent pelvic radiation. Adjuvant treatment was significantly associated with a decreased risk of recurrence (p = 0.04). Compared with no adjuvant therapy, patients who received brachytherapy or brachytherapy/chemotherapy had improved recurrence-free survival (HR 0.59, 95% CI 0.40–0.86; HR 0.65, 95% CI 0.49–0.88, respectively) and overall survival (HR 0.53, 95% CI 0.35–0.79; HR 0.49, 95% CI 0.35–0.69, respectively). Improved survival with brachytherapy and brachytherapy/chemotherapy persisted on multivariable analyses. Chemotherapy alone was also associated with improved overall survival compared with no adjuvant treatment (HR 0.55, 95% CI 0.37–0.81). Adjuvant therapy was associated with a decreased risk of recurrence relative to observation alone. Adjuvant cuff brachytherapy with and without chemotherapy was associated with improved survival outcomes in patients with early stage uterine serous carcinoma. • Treatment approaches for patients with early stage uterine serous carcinoma vary. • Use of adjuvant therapy is associated with decreased risk of recurrence relative to surveillance. • Vaginal cuff brachytherapy both with and without chemotherapy is associated with improved survival outcomes. • Patients with early stage uterine serous carcinoma should be offered vaginal cuff brachytherapy. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the clinical outcome in locally advanced cervical cancer (LACC) after image-guided adaptive brachytherapy (IGABT) with combined intracavitary and interstitial (IC/IS) techniques using the hybrid Venezia applicator (Elekta AB, Sweden). LACC patients (UICC Stage IIB – IVB) treated with radiochemotherapy followed by IGABT with the hybrid IC/IS Venezia applicator at a single institution were retrospectively analyzed. Treatment comprised EBRT of the pelvis with 45 Gy and concomitant weekly cisplatin chemotherapy (40 mg/m2) followed by MRI-based IGABT. Dosimetry, oncological outcome and toxicity were investigated. Forty-six patients underwent a total of 184 fractions of IGABT between 2017 and 2020. Median follow-up was 24 months. Combined IC/IS techniques were used in 40 patients (87%). The median HRCTV volume was 31.2 cm3 and the median HRCTV D 90% was 92.3 Gy (EQD2 10). The median D 2cm 3 was 74.8 Gy for bladder, 57.9 Gy for rectum, 60.0 Gy for sigmoid and 52.2 Gy for bowel (EQD2 3). The 3-yr actuarial rates were 97.6% for local control, 97.6% for pelvic control, 59.9% for distant metastasis-free survival and 81.6% for overall survival. The crude rate for G2 and G3 late toxicity was 21.7% and 4.3%. IGABT with the hybrid Venezia applicator and a pronounced use of a combined IC/IS technique achieved high target doses, while maintaining low doses to organs at risk, leading to excellent local control and overall survival rates with acceptable toxicity. • Combined intracavitary and interstitial brachytherapy achieves high target doses. • This leads to excellent local control. • Toxicity with this combined approach is acceptable. • Distant recurrence is common; improvements in distant control are warranted. [ABSTRACT FROM AUTHOR]

Objective: To explore the effectiveness and safety of ultrasound-guided sacral anesthesia in intracavitary and/or interstitial brachytherapy for cervical cancer patients., Method: A retrospective analysis was conducted on a total of 1039 intracavitary and/or interstitial brachytherapy involving 220 patients in our department from December 7, 2020 to March 21, 2024. The study assessed the satisfaction with anesthesia, changes in vital signs, onset time of anesthesia, dosage of anesthetic drugs, duration of anesthesia, and incidence of adverse reactions., Result: The rate of satisfaction with anesthesia was 73.8 %. There were no significant differences in patients' heart rate (HR), mean arterial pressure (MAP), systolic blood pressure (SBP), or oxygen saturation (SaO 2 ) before and after anesthesia (P > 0.05). The onset time of anesthesia ranged from 20 to 35 min, the average dosage of anesthetic was 20 ml, and the duration of anesthesia lasted from 30 to 120 min. Serious adverse reactions included 2 cases of post-anesthesia syncope (associated with sacral cysts). The incidence of nausea was 2.2 %, and the total incidence of other adverse reactions, such as vomiting, urinary retention, bradycardia, anal discomfort, and dizziness, was less than 1 %., Conclusion: Ultrasound guided sacral anesthesia demonstrates significant advantages, including effective anesthesia, minimal impact on vital signs, rapid onset, prolonged maintenance, and a low incidence of adverse reactions. It is recommended for widespread application in intracavitary and/or interstitial brachytherapy for cervical cancer patients., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

To report long-term results of an outpatient template-based high-dose-rate interstitial brachytherapy (HDR ISBT) program for the treatment of gynecologic malignancies. Patients treated between 2006 and 2020 at an academic hospital with outpatient template based HDR ISBT without spinal or general anesthesia were reviewed. Patients who had previously received HDR ISBT were excluded. Baseline patient, tumor, and treatment characteristics, such as tumor size, histology, and/or total EQD2 including prior external beam radiation therapy (EBRT) were recorded. Local control and overall survival were estimated using the Kaplan-Meier method, and factors associated with local control and overall survival were evaluated using Cox regression analyses. 150 patients received HDR ISBT for a gynecologic tumor and the median follow-up time was 2.98 years (0.89–4.82). Of those, 74/150 (49%) were treated definitively, 69/150 (46%) were treated for tumor recurrence/persistence, and 7/150 (5%) were treated for durable palliation. Median tumor size was 3.00 cm (1.50–4.00). 124/150 (83%) patients received EBRT prior to HDR ISBT. Median HDR ISBT dose was 18 Gy delivered in eight fractions. Local control was 71% (64%–79%), 58% (50%–68%), and 57% (48%–67%) at one, three, and five years, respectively. On multivariate analysis, non-endometrial adenocarcinoma histology (HR = 2.423, 95% CI = 1.011–5.808, p = 0.047) and tumor size ≥ 3 cm (HR = 2.903, 95% CI 1.053–3.441, p = 0.033) were associated with lower local control. The majority of patients who received outpatient-based twice daily HDR ISBT had long-term local control. Larger tumor size and non-endometrial adenocarcinoma histology were detrimental to local control. • HDR ISBT for vaginal, vulvar, cervical, and urethral tumors yielded durable local control. • 150 patients were treated definitively, for tumor recurrence, or for durable palliation. • Local control for all patients was 71%, 58%, and 57% at one, three, and five years. • Tumor size ≥3 cm and non-endometrial adenocarcinoma histology were detrimental to local control on multivariate analysis. [ABSTRACT FROM AUTHOR]

Objectives: There are significant disparities in access to care and treatment among cervical cancer patients. Less than half of patients with locally advanced cervical cancer receive the standard of care therapy consisting of concurrent chemoradiation, followed by brachytherapy, despite significantly improved overall survival based on an analysis of the National Cancer Database. The recommended time to complete radiation therapy in advanced cervical cancer patients is < 56 days, with both pelvic control and survival decreasing when the duration of treatment is lengthened. This study explored the relationship between social vulnerability and clinical variables, including radiation treatment duration in cervical cancer patients undergoing definitive chemoradiation, including brachytherapy over a nine-year period at a single institution. Methods: By querying a cohort discovery tool, data were obtained from 108 patients with cervical cancer from 2012 to 2021 who received brachytherapy in addition to external beam radiation. Patients' census tracts were matched to indices from the Centers for Disease Control's (CDC) Social Vulnerability Index (SVI). The SVI rankings range from least vulnerable, 0, to most vulnerable, 1, for four themes: socioeconomic status, household composition and disability, minority status and language, and housing type and transportation. Clinical data, such as stage, histology, and demographic factors, were investigated. Results were analyzed using the Kruskal-Wallis rank-sum test Fisher's exact test, and Spearman's correlation. Results: Of patients included, 69% were Caucasian, 20% African American, 6.5% Hispanic, 1.9% Asian, and 1.9% American Indian/ Alaskan Native. The median SVI value when comparing patients to all census tracts in the United States was 0.43 (range: 0.0001-0.9907) in this population. Median SVI values suggested that African American patients were most vulnerable with an SVI of 0.86 (Interquartile Range [IQR]: 0.77-0.94), followed by Hispanic 0.59 (IQR: 0.46-0.79), American Indian or Alaska Native 0.56 (IQR: 0.43-0.69), Asian 0.33 (IQR: 0.22-0.44), and Caucasian 0.31 (IQR: 0.11-0.53) (p <0.001). Using 2018 FIGO staging, 58% of patients were stage III. Stage IV patients had the highest social vulnerability (0.77, IQR: 0.6-0.9). In a subset analysis of radiation treatment duration, the median time from start to end of radiation was 53 days (range: 35-127 days). There was no significant difference in length of time of radiation treatment by race (p=0.3) or stage (p>0.9). There was no relationship between SVI and radiation treatment duration (Rs =0.1). Conclusions: While social vulnerability appears to impact cervical cancer patients in regards to race and stage, increased social vulnerability was not associated with increased radiation treatment duration. Other factors, such as time to diagnosis, initiation of treatment, or accessibility to follow-up, may be more reflective of social vulnerability than treatment duration when a committed team works to mitigate obstacles to care during the course of radiation. [ABSTRACT FROM AUTHOR]