Introduction/Background To investigate the feasibility and early clinical outcomes of combined intracavitary (IC) and interstitial (IS) image-guided adaptive brachytherapy (IGABT) as curative and definitive treatment of patients treated with chemoradiotherapy (CCRT) for locally advanced cervical cancer treated (LACC)

Methodology Patients with histologically proven cervical cancer (FIGO 2018 stage IB-IVA) treated by brachytherapy after CCRT at our institution between 2017 and 2020 were reviewed.

Results Patients with LACC FIGO 2018 stages (IB 20.4%; II 31.7%, III 45.8%, IV 2.1%) underwent brachytherapy at our institution, 53.5% of them underwent combined brachytherapy technique (IC/IS). The median number of implanted catheters was 3 (range, 1–6 catheters). With a median follow-up of 21.6 (95% confidence interval, [19.1–23.5]) months, local relapse was observed in nine patients (6.3%), with four of them with persistent and progressive disease. The estimated 2-year local and pelvic relapse free survival were respectively 92% (95% confidence interval, [84%-96%]) and 90% [83%-94%]. The estimated 2-year disease free survival for the entire population was 80% [71%-87%]. The 2- year OS rate for the entire population was 92% [84%-96%]. Acute toxicity G3 was reported in two (1.4%) patients. High grade late toxicity (grade 3) was reported in 9 (6.3%) patients

Conclusion Combined IC/IS brachytherapy for LACC allows to reach recommended doses to achieve local control even in large tumours after CCRT improving target volume coverage with low rates of acute morbidity. Hybrid brachytherapy technique (EC/IS) is essential to have a favourable scenario at the time of brachytherapy to correctly treat locally advanced cervical cancers.