Johannes Knoth, Remi A Nout, Richard Pötter, Dr Umesh Mahantshetty, Ina Jürgenliemk-Schulz, Christine Haie-Meder, Israel Fortin, Lars U Fokdal, Alina Sturdza, Peter Hoskin, Barbara Segedin, Kjersti Bruheim, Fleur Huang, Bhavana Rai, Rachel Cooper, Marie A D Haverkort, Erik van Limbergen, Bradley R Pieters, Li Tee Tan, Daniela Boryshchuk, Robin Ristl, Rohini Hawaldar, Sadhana Kannan, Astrid A C de Leeuw, Nicole Eder-Nesvacil, Kari Tanderup, Christian Kirisits, Jacob C Lindegaard, Maximilian P Schmid
{"title":"局部晚期宫颈癌放化疗和IGABT后远处转移的研究。","authors":"Johannes Knoth, Remi A Nout, Richard Pötter, Dr Umesh Mahantshetty, Ina Jürgenliemk-Schulz, Christine Haie-Meder, Israel Fortin, Lars U Fokdal, Alina Sturdza, Peter Hoskin, Barbara Segedin, Kjersti Bruheim, Fleur Huang, Bhavana Rai, Rachel Cooper, Marie A D Haverkort, Erik van Limbergen, Bradley R Pieters, Li Tee Tan, Daniela Boryshchuk, Robin Ristl, Rohini Hawaldar, Sadhana Kannan, Astrid A C de Leeuw, Nicole Eder-Nesvacil, Kari Tanderup, Christian Kirisits, Jacob C Lindegaard, Maximilian P Schmid","doi":"10.1016/j.ijrobp.2025.04.037","DOIUrl":null,"url":null,"abstract":"<p><p>Purpose This study aimed to assess patterns and risks of distant metastasis (DM) in cervical cancer patients treated with chemoradiotherapy and MR-image-guided adaptive brachytherapy (IGABT) and to explore a potential dose-effect relationship of concomitant cisplatin. Materials and Methods Data were derived from EMBRACE-I, an international, prospective, multicenter cohort study conducted at 24 centers across Europe, Asia, and North America from July 30, 2008, to December 29, 2015. The study included 1416 patients with biopsy-confirmed cervical cancer (FIGO<sub>2009</sub> stage IB-IVA or stage IVB limited to paraaortic lymph nodes). Treatment involved external beam radiotherapy (45-50.4 Gy), weekly cisplatin (40 mg/m², 30 mg/m², or paused), and IGABT. DM was defined as extra-pelvic recurrence excluding paraaortic nodes. Results The analysis included 1318 patients with a median age of 49 years and a median follow-up of 52 months. The 5-year cumulative incidence of DM was 14%, with the lungs (26%), mediastinal lymph nodes (15%), and bones (10%) identified as the most common metastatic sites. Key risk factors for DM included non-squamous histology (HR: 1.89, 95% CI: 1.30-2.75), nodal involvement at diagnosis (pelvic-only nodes: HR: 1.56, 95% CI: 1.07-2.26; paraaortic nodes: HR: 3.15, 95% CI: 1.93-5.16), and large target volume at brachytherapy (HR: 1.93, 95% CI: 1.21-3.08). Patients receiving fewer than 4 cycles of chemotherapy demonstrated a significantly higher risk of DM (HR: 1.52, 95% CI: 1.08-2.13). Conclusion DM is a substantial burden in patients with locally advanced cervical cancer, with the lungs, distant lymph nodes, and bones being the most frequent sites. Risk factors such as non-squamous histology, nodal involvement, and large target volumes at brachytherapy are critical considerations for identifying high-risk patients in future studies. These findings highlight the need for tailored strategies to mitigate DM in this patient population.</p>","PeriodicalId":14215,"journal":{"name":"International Journal of Radiation Oncology Biology Physics","volume":" ","pages":""},"PeriodicalIF":6.4000,"publicationDate":"2025-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Distant metastasis after chemoradiation and IGABT in locally advanced cervical cancer.\",\"authors\":\"Johannes Knoth, Remi A Nout, Richard Pötter, Dr Umesh Mahantshetty, Ina Jürgenliemk-Schulz, Christine Haie-Meder, Israel Fortin, Lars U Fokdal, Alina Sturdza, Peter Hoskin, Barbara Segedin, Kjersti Bruheim, Fleur Huang, Bhavana Rai, Rachel Cooper, Marie A D Haverkort, Erik van Limbergen, Bradley R Pieters, Li Tee Tan, Daniela Boryshchuk, Robin Ristl, Rohini Hawaldar, Sadhana Kannan, Astrid A C de Leeuw, Nicole Eder-Nesvacil, Kari Tanderup, Christian Kirisits, Jacob C Lindegaard, Maximilian P Schmid\",\"doi\":\"10.1016/j.ijrobp.2025.04.037\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>Purpose This study aimed to assess patterns and risks of distant metastasis (DM) in cervical cancer patients treated with chemoradiotherapy and MR-image-guided adaptive brachytherapy (IGABT) and to explore a potential dose-effect relationship of concomitant cisplatin. Materials and Methods Data were derived from EMBRACE-I, an international, prospective, multicenter cohort study conducted at 24 centers across Europe, Asia, and North America from July 30, 2008, to December 29, 2015. The study included 1416 patients with biopsy-confirmed cervical cancer (FIGO<sub>2009</sub> stage IB-IVA or stage IVB limited to paraaortic lymph nodes). Treatment involved external beam radiotherapy (45-50.4 Gy), weekly cisplatin (40 mg/m², 30 mg/m², or paused), and IGABT. DM was defined as extra-pelvic recurrence excluding paraaortic nodes. Results The analysis included 1318 patients with a median age of 49 years and a median follow-up of 52 months. The 5-year cumulative incidence of DM was 14%, with the lungs (26%), mediastinal lymph nodes (15%), and bones (10%) identified as the most common metastatic sites. Key risk factors for DM included non-squamous histology (HR: 1.89, 95% CI: 1.30-2.75), nodal involvement at diagnosis (pelvic-only nodes: HR: 1.56, 95% CI: 1.07-2.26; paraaortic nodes: HR: 3.15, 95% CI: 1.93-5.16), and large target volume at brachytherapy (HR: 1.93, 95% CI: 1.21-3.08). Patients receiving fewer than 4 cycles of chemotherapy demonstrated a significantly higher risk of DM (HR: 1.52, 95% CI: 1.08-2.13). Conclusion DM is a substantial burden in patients with locally advanced cervical cancer, with the lungs, distant lymph nodes, and bones being the most frequent sites. Risk factors such as non-squamous histology, nodal involvement, and large target volumes at brachytherapy are critical considerations for identifying high-risk patients in future studies. These findings highlight the need for tailored strategies to mitigate DM in this patient population.</p>\",\"PeriodicalId\":14215,\"journal\":{\"name\":\"International Journal of Radiation Oncology Biology Physics\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":6.4000,\"publicationDate\":\"2025-05-10\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"International Journal of Radiation Oncology Biology Physics\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.ijrobp.2025.04.037\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"International Journal of Radiation Oncology Biology Physics","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.ijrobp.2025.04.037","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"ONCOLOGY","Score":null,"Total":0}
Distant metastasis after chemoradiation and IGABT in locally advanced cervical cancer.
Purpose This study aimed to assess patterns and risks of distant metastasis (DM) in cervical cancer patients treated with chemoradiotherapy and MR-image-guided adaptive brachytherapy (IGABT) and to explore a potential dose-effect relationship of concomitant cisplatin. Materials and Methods Data were derived from EMBRACE-I, an international, prospective, multicenter cohort study conducted at 24 centers across Europe, Asia, and North America from July 30, 2008, to December 29, 2015. The study included 1416 patients with biopsy-confirmed cervical cancer (FIGO2009 stage IB-IVA or stage IVB limited to paraaortic lymph nodes). Treatment involved external beam radiotherapy (45-50.4 Gy), weekly cisplatin (40 mg/m², 30 mg/m², or paused), and IGABT. DM was defined as extra-pelvic recurrence excluding paraaortic nodes. Results The analysis included 1318 patients with a median age of 49 years and a median follow-up of 52 months. The 5-year cumulative incidence of DM was 14%, with the lungs (26%), mediastinal lymph nodes (15%), and bones (10%) identified as the most common metastatic sites. Key risk factors for DM included non-squamous histology (HR: 1.89, 95% CI: 1.30-2.75), nodal involvement at diagnosis (pelvic-only nodes: HR: 1.56, 95% CI: 1.07-2.26; paraaortic nodes: HR: 3.15, 95% CI: 1.93-5.16), and large target volume at brachytherapy (HR: 1.93, 95% CI: 1.21-3.08). Patients receiving fewer than 4 cycles of chemotherapy demonstrated a significantly higher risk of DM (HR: 1.52, 95% CI: 1.08-2.13). Conclusion DM is a substantial burden in patients with locally advanced cervical cancer, with the lungs, distant lymph nodes, and bones being the most frequent sites. Risk factors such as non-squamous histology, nodal involvement, and large target volumes at brachytherapy are critical considerations for identifying high-risk patients in future studies. These findings highlight the need for tailored strategies to mitigate DM in this patient population.
期刊介绍：
International Journal of Radiation Oncology • Biology • Physics (IJROBP), known in the field as the Red Journal, publishes original laboratory and clinical investigations related to radiation oncology, radiation biology, medical physics, and both education and health policy as it relates to the field.
This journal has a particular interest in original contributions of the following types: prospective clinical trials, outcomes research, and large database interrogation. In addition, it seeks reports of high-impact innovations in single or combined modality treatment, tumor sensitization, normal tissue protection (including both precision avoidance and pharmacologic means), brachytherapy, particle irradiation, and cancer imaging. Technical advances related to dosimetry and conformal radiation treatment planning are of interest, as are basic science studies investigating tumor physiology and the molecular biology underlying cancer and normal tissue radiation response.
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