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Role of vaginal brachytherapy boost following adjuvant external beam radiotherapy in cervical cancer: Turkish Society for Radiation Oncology Gynecologic Group Study (TROD 04-002)
  1. Melis Gultekin1,
  2. Caglayan Selenge Beduk Esen1,
  3. Beril Balci2,
  4. Senem Alanyali2,
  5. Berna Akkus Yildirim3,
  6. Ozan Cem Guler3,
  7. Sezin Yuce Sari1,
  8. Sefika Arzu Ergen4,
  9. Ismet Sahinler4,
  10. Ilknur Alsan Cetin5,
  11. Cem Onal3,
  12. Ferah Yildiz1 and
  13. Zeynep Ozsaran2
  1. 1Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
  2. 2Radiation Oncology, Ege University Faculty of Medicine, Izmir, Turkey
  3. 3Radiation Oncology, Baskent University Faculty of Medicine, Adana Dr. Turgut Noyan Research and Treatment Center, Adana, Turkey
  4. 4Radiation Oncology, Istanbul University-Cerrahpasa Cerrahpasa Faculty of Medicine, Istanbul, Turkey
  5. 5Radiation Oncology, Marmara University School of Medicine, Istanbul, Turkey
  1. Correspondence to Dr Melis Gultekin, Radiation Oncology, Hacettepe University Faculty of Medicine, Ankara 06100, Turkey; melisbahadir{at}


Objective There are a limited number of studies supporting vaginal brachytherapy boost to external beam radiotherapy in the adjuvant treatment of cervical cancer. The aim of this study was to assess the impact of the addition of vaginal brachytherapy boost to adjuvant external beam radiotherapy on oncological outcomes and toxicity in patients with cervical cancer.

Methods Patients treated with post-operative external beam radiotherapy ± chemotherapy ± vaginal brachytherapy between January 2001 and January 2019 were retrospectively evaluated. The treatment outcomes and prognostic factors were analyzed in patients treated with external beam radiotherapy with or without vaginal brachytherapy.

Results A total of 480 patients were included in the analysis. The median age was 51 years (range 42–60). At least two intermediate risk factors were observed in 51% of patients, while 49% had at least one high-risk factor. The patients in the external beam radiotherapy + vaginal brachytherapy group had worse prognostic factors than the external beam radiotherapy alone group. With a median follow-up time of 56 months (range 33–90), the 5-year overall survival rate was 82%. There was no difference in 5-year overall survival (87% vs 79%, p=0.11), recurrence-free survival (74% vs 71%, p=0.49), local recurrence-free survival (78% vs 76%, p=0.16), and distant metastasis-free survival (85% vs 76%, p=0.09) rates between treatment groups. There was no benefit of addition of vaginal brachytherapy to external beam radiotherapy in patients with positive surgical margins. In multivariate analysis, stage (overall survival and local recurrence-free survival), tumor histology (recurrence-free survival, local recurrence-free survival and distant metastasis-free survival), parametrial invasion (recurrence-free survival and distant metastasis-free survival), lymphovascular space invasion (recurrence-free survival), and lymph node metastasis (distant metastasis-free survival) were found as negative prognostic factors.

Conclusion Adding vaginal brachytherapy boost to external beam radiotherapy did not provide any benefit in local control or survival in patients with cervical cancer.

  • radiotherapy
  • brachytherapy
  • uterine cervical neoplasms

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  • Contributors Each of the authors has contributed to, read, and approved the paper.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study was approved by the Central Ethical Commitee at Hacettepe University (reference: GO 20/578).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.