Correlation between High Risk CTV during CT-based Intracavitary Brachytherapy and Local Control and Disease Free Survival of Cervical Carcinoma after Treatment
Keywords:
Cervical cancer, Radiation, CT-based IGBT, High risk CTV, BrachytherapyAbstract
Background: The current standard of brachytherapy in cervical cancer is a 3D technique using 3D image delineation of high-risk clinical target volume (HR-CTV), which magnetic resonance imaging-based (MRI-based) provides clearer visualization compared to computed tomography (CT) image and benefits in predicting treatment outcomes. Due to cost limitations, MRI cannot be used in common. Objective: This study compiles the treatment outcomes of CT-based brachytherapy performed at Lampang Cancer Hospital and analyzes the HR-CTV delineated by CT to assess whether it could predict treatment outcomes Method: This retrospective study analyzed data from 194 cervical cancer patients who underwent external beam RT combined with CT-based intracavitary brachytherapy using tandem with ovoid or Fletcher applicators. Kaplan-Meier and log-rank tests were used to calculate local control (LC) and disease-free survival (DFS). The relationship between size of HR-CTV at the first brachytherapy session and treatment outcomes was assessed using Cox-regression analysis. Result: The median follow-up period was 26 months. 2-year LC was 85.3%, DFS was 80.5%. HR-CTV sizes were categorized into three groups: < 20 cm3, 20-30 cm3, and > 30 cm3. During the first 6 months, LC rates were 100% for the < 20 and 20-30 cm3 groups, compared to 93.4% for > 30 cm3 group. 2-year LC for three groups were 92.6%, 86.2%, 78.3% (p = .014). 2-year DFS were 88.0%, 77.3%, 74.7%, respectively (p = .027). HR-CTV size < 20 cm3 was significantly associated with better LC (HR 0.222, p = .007) and DFS (HR 0.393, p = .014) compared to > 30 cm3 group. Conclusion: The size of HR-CTV delineated by the CT-based image during the first brachytherapy session was associated with LC and DFS. Within the first 6 months, HR-CTV size < 30 cm3 demonstrated the best treatment response. From univariate analysis, HR-CTV < 20 cm3 group showed a strong association with better LC and DFS compared to > 30 cm3 group.
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