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2022-RA-743-ESGO Improving risk stratification for cervical cancer in patients treated with concurrent chemoradiation and MRI-image guided adaptive brachytherapy in EMBRACE study: results from an international collaborative translational research study (BIOEMBRACE-I)
  1. Supriya Chopra1,
  2. Ekaterina S Jordanova2,
  3. Nanda Horeweg2,
  4. Kedar Deodhar3,
  5. Santosh Menon4,
  6. Venkatesh Pai5,
  7. Tynisha Rafael2,
  8. Umesh Mahantshetty4,
  9. Barbara Segedin6,
  10. Nadia Giannakopoulos7,
  11. Fleur Huang7,
  12. Kjersti Bruheim8,
  13. Marga Perz9,
  14. Bhavana Rai10,
  15. Li Tee Tan11,
  16. Maximilian Schmid12,
  17. Kari Tanderup13,
  18. Richard Potter14,
  19. Tjalling Bosse2 and
  20. Remi A Nout15
  1. 1Advanced Centre for Treatment, Research and Education in Cancer (ACTREC), Tata Memorial Centre, Navi Mumbai, India
  2. 2Leiden University Medical Centre, Leiden, Netherlands
  3. 3Tata Memorial Hospital,Tata Memorial Centre, Mumbai, India
  4. 4Tata Memorial Hospital, Tata Memorial Centre, Mumbai, India
  5. 5ACTREC, Tata Memorial Centre, Navi Mumbai, India
  6. 6Institute of Oncology, Ljubljana, Slovenia
  7. 7Cross Cancer Institute, Edmonton, AB, Canada
  8. 8Oslo University Hospital, Oslo, Norway
  9. 9Navarrabiomer-Centro De Investigacion Biomaedica, Pampalona, Spain
  10. 10Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
  11. 11Cambridge University Hospital, Addenbriooke, UK
  12. 12Medical University Vienna, Vienna, Austria
  13. 13Aarhus University Hospital, Aarhus University, Denmark
  14. 14Medical Univeristy of Vienna, Vienna, Austria
  15. 15Erasmus University Medical Centre, Rotterdam, Netherlands


Introduction/Background BIOEMBRACE-I is a translational sub-study of EMBRACE-I, initiated to improve risk stratification for cervical cancer patients treated with chemoradiation and MRI-guided brachytherapy

Methodology Between 2018–2021, patients were included from EMBRACE study sites. Prognostic factors at baseline and brachytherapy (FIGO stage, nodal involvement, histology, necrosis on MR, poor response indicated by high risk clinical target volume at brachytherapy (HRCTV-BT> 40 cc) were included. In the first phase, immunohistochemistry for p16 and L1CAM was performed. p16 was categorized as ‘positive’ or ‘negative’ and L1CAM was categorized as ‘0–10%’, 10–50% or 50% overexpression. Response to EBRT and disease outcomes were tested after including p16 and L1CAM along with other prognostic factors. Univariate and multivariable analysis (MVA) was performed.

Results Eight EMBRACE sites included 264 patients with a median follow up of 50 months (21–67). Distribution of prognostic factors, including p16 and L1CAM expression is summarized in Table 1.The median HRCTV-BT and D-90 was 30 cm3 (IQR 22–44) and 89 Gy (IQR 86–95 Gy). p-16 positive patients had higher nodal positivity (96% vs. 3%, p=0.0001) or necrosis on MRI (73% vs. 26%, p=0.01) and proportion of HRCTV-BT < 40cc (72.8% vs. 54.5%, p=0.03). The 5-year pelvic, disease control and disease free survival (DFS) was 87.3%,72.6% and 66.7% respectively. On MVA, FIGO stage (HR=5.4, p<0.0001), necrosis on MR (HR =2.6, p=0.005) and p-16 negative status (HR=2.1, p=0.07) predicted for HRCTV-BT > 40cc. For pelvic and disease control HRCTV-BT> 40cc and LICAM > 50% were independent predictors, though reduced pelvic control was also observed at L1CAM >10% on univariate analysis. For DFS, nodal status and HRCTV-BT> 40cc were independent predictors (table 1).

Abstract 2022-RA-743-ESGO Table 1

Conclusion FIGO stage, necrosis on MR and p16 negative status predicted for HRCTV-BT > 40 cc. HRCTV-BT > 40 cc and L1CAM are prognostic for pelvic and disease control. PDL-1 analysis is ongoing.

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