Introduction To evaluate early outcomes and toxicities among locally advanced cervical cancer patients treated with concurrent chemoradiation using volumetric-modulated arc therapy (VMAT) followed by 3D image-guided brachytherapy (3D-IGBT)To evaluate early outcomes and toxicities among locally advanced cervical cancer patients treated with concurrent chemoradiation using volumetric-modulated arc therapy (VMAT) followed by 3D image-guided brachytherapy (3D-IGBT).

Methods A prospective, interventional study on 72 patients with 2018 International Federation of Gynecology and Obstetrics stage IB3-IIIC2 disease treated with concurrent chemoradiation using VMAT followed by 3D-IGBT according to EMBRACE-II protocol. Treatment response, locoregional control, systemic control, and toxicities were primary endpoints in all patients.

Results Median of body volume received 43 Gy was 1589.1 cm³ (range 1214.8–2574.8). Median of high-risk clinical target (CTV-HR) volume was 18.8 cm³ (range 8.6 – 61.2), median dose to 90% of CTV-HR was 90.6 Gy (range 86.8–99.6). The mean of D2cc to bladder, rectum, and sigmoid were 75.8, 55.2, and 62.1 Gy, respectively. The complete response rate was 95.8%, and locoregional control and systemic control were 95.8% and 83.3%, respectively, at a median follow-up of 15 months (range 9–19). Grade ≥ 3 acute toxicities were observed in less than 10% of cases, except for neutropenia (accounted for 31.9%). Extended-field radiation increased the rate of nausea, fatigue, and thrombocytopenia. No grade ≥ 3 proctitis or cystitis was observed, but vaginal stenosis grade 3 was noted in 8.3% of patients.

Conclusion/Implications Concurrent chemoradiation therapy using VMAT and 3D-IGBT resulted in a high response rate and locoregional control with manageable toxicities in patients with locally advanced cervical cancer.