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Introduction The current literature is insufficient to guide care for patients with cervical cancer ineligible for brachytherapy. Stereotactic ablative radiotherapy boost is a clinical necessity for these patients, but highly debated among radiation oncologists. Objective Toreport toxicity and survival outcomes in a largecohort of patients with locally advanced cervical cancer treated with a non- invasivestereotactic ablative radiotherapy boost instead of brachytherapy Methods Patients with locally advanced cervical cancer were entered, between January 2008 and December 2018, who were recommended definitive intent external boost after pelvic radiotherapy to 45-50.4 Gy concurrent with weekly cisplatin and simultaneous/sequential nodal boost up to 55-66 Gy. Simulation CT was facilitated using radioopaque fiducials, empty rectum, dedicated bladder filling, and whole body vaculoplastic immobilization. Kaplan- Meier survival estimates were used to report local/regional recurrences, distant metastases, cancer- specific survival, and overall survival. Results A total of 25 patients were analyzed. Median follow- up was 25 months (range 6-54). Patients received stereotactic ablative radiotherapy due to refusal of brachytherapy (9/25, 36%), medical co- morbidities limiting implantation (9/25, 36%), or technical infeasibility (7/25, 28%). Typical fractionation was 24-30 Gy in 4-5 fractions (24/25, 96%). The most common long- term toxicity was grade 1-2 vaginal dryness, discomfort, stenosis, and/ or dyspareunia (4/25, 16%). One patient had new posttreatment grade 4 fistula in an area of previous tumor erosion (1/25, 4%). Overall survival, cancer specific survival, loco- regional control, and distant control were 95.5%, 100%, 95.5%, and 89.1%, respectively, at 2 years. Conclusion Further study of stereotactic ablative radiotherapy boost for cervical cancer is needed; a brachytherapy- similar approach portends clinical success with 95.5% overall survival and loco- regional control at 2 years. [ABSTRACT FROM AUTHOR]

Background and Purpose: Our objective was to determine whether stereotactic body radiotherapy (SBRT), intensity-modulated radiation therapy (IMRT), and brachytherapy boost techniques have comparable overall survival in treating cervical cancer when adjusted for known prognostic factors. Materials and Methods: We used the National Cancer Database to study women with invasive cervical cancer who were treated with radiation between 2004 and 2013. A logistic regression modelwas built to identify factors associated with the receipt of SBRTand IMRT. Outcomes were compared using Kaplan-Meier and propensity score matching. Results: Of all 15,905 patients, 14,394 (90.5%) received brachytherapy, 42 (0.8%) received SBRT, and 1468 (9.2%) received IMRT. After propensity scorematching, therewas no significant difference in overall survival (OS) for patientswho received SBRT boost versus brachytherapy boost (hazard ratio = 1.477, 95% confidence interval = 0.746Y2.926, P = 0.263) but a significant OS detriment in patients who received IMRT boost versus brachytherapy boost (hazard ratio = 1.455, 95% confidence interval = 1.300Y1.628, P G 0.001). Conclusions: In a propensity-matched analysis, those who received SBRT boost had equal OS when compared with brachytherapy, but those who received IMRT boost had worse OS when compared with brachytherapy. [ABSTRACT FROM AUTHOR]

Objective: The aim of the studywas to determine whether patient characteristics are associated with radiation treatment noncompliance. Methods/Materials: We retrospectively studied 244 patients with cervical cancer treated with chemoradiation between May 2006 and August 2015 at a safety net health center. Compliance with treatment was defined as missing less than 2 days of scheduled radiation. Results: Treatment records revealed a compliance rate of 50.8% in this population. Factors associated with noncompliance were younger age (hazard ratio [HR], 1.037; P = 0.004), presence of psychiatric diagnosis (HR, 0.581; P = 0.044), and having insurance (HR, 0.484; P = 0.022). Noncompliance was associated with a decrease in disease-free survival (HR, 0.555; P = 0.042) but was not associated with overall survival. International Federation of Gynecology and Obstetrics stage was associated with detriment in overall survival on multivariate analysis (HR, 2.034; P = 0.001). Conclusions: Younger patients, those with psychiatric illness, and those with insurance define a group that is more likely to be noncompliant with treatment and hence may require up-front intervention to improve outcomes. [ABSTRACT FROM AUTHOR]