Introduction/Background Locally advanced cervical cancer (LACC) is a major global health issue and optimal treatment includes concurrent chemoradiotherapy (CCRT) followed by brachytherapy. In this study, we retrospectively evaluated the clinical outcomes of LACC patients over a five year period, treated with External Beam Radiotherapy (EBRT) and MRI based Adaptive Brachytherapy (IGABT), with a focus on survival outcomes and patterns of recurrence.

Methodology We reviewed data from 71 patients treated for LACC in our institution between 2017 and 2021. All eligible patients were treated with CCRT and IGABT with 45Gy-50.4 Gy/25–28 fractions EBRT and 3–4 fractions of intracavitary brachytherapy at 7Gy/fraction.

Histology, staging, dose-volume constraints (DVC), EBRT plans and sites of recurrence were analysed using electronic records, imaging and planning software and medical notes.

Results The optimal treatment time of <55 days was achieved in 93% of cases. At a mean follow-up time of 36 months, 16 (22.5%) patients had recurred, with a mean time to recurrence of 21.3 months. Six patients (8.5%) had pelvic recurrences with 2 having local relapse at the cervix and 4 having regional-nodal recurrences.

Five patients (7%) had distant metastasis and a further 5 had both loco-regional and distant progression. The D90% of the high-risk clinical target volume (HR-CTV) was below the recommended 85Gy for the 2 patients with local cervical recurrence. Analysis of the 4 nodal failures demonstrated recurrence above the cranial pelvic field.

Conclusion Our findings suggest that further improvements in LACC treatment are possible.

The D90% is often limited by doses to the Organs at Risk(OARs) however potential escalation of brachytherapy and introduction of interstitial brachytherapy could improve this. The 3 risk group classification for extending elective clinical target volumes may improve local control and overall survival. Limitations of this study include its retrospective nature and single-institution experience.

Disclosures Nil