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Intensity-modulated radiotherapy/Volumetric modulated Arc therapy including four Brachytherapy fractions versus 3D conformal radiotherapy containing five Brachytherapy fractions in the treatment of cervical cancer

Year: 2026

Type: article

Abstract: BACKGROUND: Definitive radiochemotherapy with external beam radiotherapy and brachytherapy is standard for locally advanced cervical cancer (LACC). Advanced techniques like intensity-modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) have replaced 3D-conformal radiotherapy (3DCRT). This study compares two institutional definitive radiotherapy treatment pathways implemented in different time periods: 3DCRT with five BT fractions and IMRT/VMAT with four BT fractions. METHODS: This retrospective single-center study included 145 patients with FIGO 2018 stage IB3–IVA LACC treated during 2008–2023. Patients received 3DCRT+5BT (2008–2016; n = 77) or IMRT/VMAT+4BT (2017–2023; n = 68) with concurrent chemotherapy. Histopathological biopsies at final BT evaluated tumor response. Dosimetric parameters (HRCTV-D90–EQD2₍₁₀₎ and OAR-D2cc for bladder, rectum, sigmoid) were analyzed. Endpoints included treatment duration, residual tumor, progression-free survival (PFS), overall survival (OS), and toxicity. RESULTS: After a median follow-up of 60 months, no significant differences were seen in PFS (HR 0.68, 95% CI 0.34–1.38, p = 0.285) or OS (HR 0.47, 95% CI 0.17–1.29, p = 0.133). Histologically confirmed residual tumor rates were 22.1% (IMRT/VMAT+4BT) vs. 31.2% (3DCRT+5BT; p = 0.262). IMRT/VMAT+4BT patients more often completed therapy within 49 days (63.2% vs. 20.8%; p < 0.001). Median HRCTV D90 EQD2₍₁₀₎ was 85.3 Gy vs. 76.5 Gy (p < 0.001) in favor of IMRT/VMAT, while OAR doses remained within limits. IMRT/VMAT showed significantly fewer gastrointestinal, genitourinary, skin, and mucosal toxicities (all p < 0.05) and less systemic deterioration. CONCLUSION: In this era-based single-institution comparison of two treatment pathways, IMRT/VMAT+4BT achieved numerically better oncologic outcomes without reaching statistical significance. IMRT/VMAT+4BT showed improved target coverage, lower toxicity, and shorter treatment duration, within the context of an integrated regimen change over time.

Source: Radiation Oncology

DOI: 10.1186/s13014-026-02834-9