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@ARTICLE{Neu:301515,
      author       = {M. Neu and C. M. Wöhrl and R. Walter and N. Balagiannis
                      and C. Poettgen and L. Käsmann$^*$ and M. Stuschke and C.
                      Dannecker and G. Stüben and K.-H. Kahl},
      title        = {{M}ultimodal chemoradiotherapy including interstitial
                      brachytherapy enhances outcomes in {FIGO} stage {IVA}
                      cervical cancer: a focus on tumor control and quality of
                      life.},
      journal      = {Strahlentherapie und Onkologie},
      volume       = {nn},
      issn         = {0179-7158},
      address      = {Heidelberg},
      publisher    = {Springer Medizin},
      reportid     = {DKFZ-2025-01052},
      pages        = {nn},
      year         = {2025},
      note         = {epub},
      abstract     = {This study was performed to evaluate the outcomes of
                      advanced radiotherapy techniques, including image-guided
                      adaptive brachytherapy (IGABT), in International Federation
                      of Gynecology and Obstetrics (FIGO) stage IVA cervical
                      cancer patients with adjacent organ infiltration. A further
                      aim was to identify prognostic factors influencing overall
                      survival (OS) and local control (LC) in these patients, with
                      a particular focus on toxicity and patient-reported outcomes
                      (PROs).This retrospective, single-center study included 31
                      patients with FIGO stage IVA cervical cancer treated with
                      definitive chemoradiotherapy between 2010 and 2020. All 31
                      patients underwent external-beam radiotherapy (EBRT), with
                      concurrent cisplatin-based chemotherapy (CTX) administered
                      in 25 cases and additional high-dose-rate brachytherapy (BT)
                      performed in 24 cases. Treatment-related adverse events were
                      categorized in accordance with the Common Terminology
                      Criteria for Adverse Events (CTCAE; version 5.0) [1]. PROs
                      were evaluated using the European Organization for Research
                      and Treatment of Cancer Quality of Life Questionnaire
                      version 3.0 (EORTC QLQ-C30), while sexual function was
                      assessed through three specific questions adapted from the
                      EORTC QLQ-BR23 module.Median OS was estimated at 51.7
                      months, with 2‑ and 5‑year OS rates of 58.1 and
                      $46.2\%,$ respectively. Median progression-free survival
                      (PFS) was 48.1 months $(95\%$ CI: 0-96.2 months), with 2‑
                      and 5‑year PFS rates of 52 and $37\%.$ The 10-year LC
                      probability was $70.4\%,$ showing a significant association
                      with improved OS (p = 0.0039). Eastern Cooperative Oncology
                      Group (ECOG) performance status (p = 0.014) and nodal
                      involvement were identified as prognostic factors. The
                      estimated median OS was 108 months for patients treated with
                      BT and 51.7 months for those without. Patients receiving six
                      fractions or a cumulative BT dose of ≥ 24 Gy demonstrated
                      improved 5‑year OS rates of $62.3\%,$ although the
                      difference was not statistically significant. Acute
                      toxicities were reported in $83.9\%$ of patients, primarily
                      grades 1-2, with severe complications such as fistula
                      formation occurring in $16.1\%.$ Late toxicities,
                      predominantly affecting the gastrointestinal and urogenital
                      systems, were observed in $45.2\%$ of patients.
                      Patient-reported outcomes indicated mild to moderate
                      impairments of quality of life, with fatigue and
                      gastrointestinal symptoms being the most frequently reported
                      issues.Advanced radiotherapy, particularly IGABT, achieves
                      durable LC in patients with FIGO stage IVA cervical cancer,
                      supporting its use as a cornerstone of curative-intent
                      treatment. However, systemic progression remains a major
                      challenge, highlighting the need for novel therapeutic
                      strategies, including immunotherapy and liquid biopsy for
                      treatment monitoring. Future prospective trials are
                      essential to validate these findings and refine therapeutic
                      protocols, particularly for high-risk subgroups. Ensuring
                      equitable access to these advanced treatments is critical
                      for improving global outcomes in cervical cancer care.},
      keywords     = {Bladder or rectal infiltration (Other) / High-dose-rate
                      brachytherapy (Other) / Image-guided radiotherapy (Other) /
                      Locally advanced cervical cancer (Other) / Patient-reported
                      outcome measures (Other)},
      cin          = {MU01},
      ddc          = {610},
      cid          = {I:(DE-He78)MU01-20160331},
      pnm          = {899 - ohne Topic (POF4-899)},
      pid          = {G:(DE-HGF)POF4-899},
      typ          = {PUB:(DE-HGF)16},
      pubmed       = {pmid:40399493},
      doi          = {10.1007/s00066-025-02407-x},
      url          = {https://inrepo02.dkfz.de/record/301515},
}