Multimodal chemoradiotherapy including interstitial brachytherapy enhances outcomes in FIGO stage IVA cervical cancer: a focus on tumor control and quality of life.

Abstract

Purpose: This study was performed to evaluate the outcomes of advanced radiotherapy techniques, including image-guided adaptive brachytherapy (IGABT), in International Federation of Gynecology and Obstetrics (FIGO) stage IVA cervical cancer patients with adjacent organ infiltration. A further aim was to identify prognostic factors influencing overall survival (OS) and local control (LC) in these patients, with a particular focus on toxicity and patient-reported outcomes (PROs).

Methods: This retrospective, single-center study included 31 patients with FIGO stage IVA cervical cancer treated with definitive chemoradiotherapy between 2010 and 2020. All 31 patients underwent external-beam radiotherapy (EBRT), with concurrent cisplatin-based chemotherapy (CTX) administered in 25 cases and additional high-dose-rate brachytherapy (BT) performed in 24 cases. Treatment-related adverse events were categorized in accordance with the Common Terminology Criteria for Adverse Events (CTCAE; version 5.0) [1]. PROs were evaluated using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire version 3.0 (EORTC QLQ-C30), while sexual function was assessed through three specific questions adapted from the EORTC QLQ-BR23 module.

Results: Median OS was estimated at 51.7 months, with 2‑ and 5‑year OS rates of 58.1 and 46.2%, respectively. Median progression-free survival (PFS) was 48.1 months (95% CI: 0-96.2 months), with 2‑ and 5‑year PFS rates of 52 and 37%. The 10-year LC probability was 70.4%, showing a significant association with improved OS (p = 0.0039). Eastern Cooperative Oncology Group (ECOG) performance status (p = 0.014) and nodal involvement were identified as prognostic factors. The estimated median OS was 108 months for patients treated with BT and 51.7 months for those without. Patients receiving six fractions or a cumulative BT dose of ≥ 24 Gy demonstrated improved 5‑year OS rates of 62.3%, although the difference was not statistically significant. Acute toxicities were reported in 83.9% of patients, primarily grades 1-2, with severe complications such as fistula formation occurring in 16.1%. Late toxicities, predominantly affecting the gastrointestinal and urogenital systems, were observed in 45.2% of patients. Patient-reported outcomes indicated mild to moderate impairments of quality of life, with fatigue and gastrointestinal symptoms being the most frequently reported issues.

Conclusion: Advanced radiotherapy, particularly IGABT, achieves durable LC in patients with FIGO stage IVA cervical cancer, supporting its use as a cornerstone of curative-intent treatment. However, systemic progression remains a major challenge, highlighting the need for novel therapeutic strategies, including immunotherapy and liquid biopsy for treatment monitoring. Future prospective trials are essential to validate these findings and refine therapeutic protocols, particularly for high-risk subgroups. Ensuring equitable access to these advanced treatments is critical for improving global outcomes in cervical cancer care.