Introduction/Background Treatment of locally advanced cervical cancers with pelvic wall or surrounding organ invasion (FIGO IIIB/IVA) is a challenging situation and the clinical results have been traditionally poor. According the evolving of brachytherapy (BT) and imaging, our treatment aim has progressively become more radical and actually all patients are treated with external beam radiochemotherapy (EBRT) plus MR based Image Guided Adapted Brachytherapy (IGABT) and adjuvant chemotherapy (CT). Aim of this work is to revise this evolving trend over the past 19 years.
Methodology Since January 2000, 108 cervical cancer patients with FIGO IIIB (because pelvic wall invasion) or IVA were discussed in multidisciplinary tumour board. Patients received radiotherapy treatment or best supportive care (BSC) depending on patient‘s clinical condition and treatment options available at that time (in our centre 3D-BT was introduced in 2006, IGABT in 2012, adjuvant CT in 2013).
All patients are in prospective follow up in radiation oncology and gynaecology department.
Results 23 patients receved BSC, 19 EBRT only, 19 EBRT+ standard 3D BT, 28 received EBRT plus IGABT and 19 received EBRT plus IGABT plus adjuvant CT.
With a median follow up time of 53 months, 3 years overall survival was respectively 0%, 16.5%, 26.5%, 48.5% and 77.5%.
Excluding patients who received BSC from further analysis, the 3 years DFS was respectively 11%, 11%, 36% and 58%.
3 year local control was respectively 17.5%, 43%, 91.5% and 100%
3 year systemic control was respectively 53.5%, 62%, 49% and 78.5% (Figure 1)
Conclusion The evolution the radiotherapy technique is shaping the outcomes of cervical cancer patients, even in the most difficult cases. If tumour control is at hand, chemotherapy strategies to improve systemic control have to be identified.
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