Patterns of Relapse in Patients with Locally Advanced Cervical Cancer after Image Guided Brachytherapy

Background: In the treatment of locally advanced cervical cancer (LACC), brachytherapy (BT) is a pivotal treatment modality, used in conjunction with external beam radiotherapy (EBRT). However, even with advancements in EBRT and BT techniques, the occurrence of local relapse continues to pose significant challenges. Objective: This research aimed to examine the recurrence patterns following the administration of concomitant chemoradiotherapy (CCRT) and subsequent enhancement with image-guided brachytherapy (IGBT). Subjects and methods: The research involved 40 patients diagnosed with locally advanced cervical cancer. These individuals underwent CCRT, subsequently enhanced by IGBT, as part of a phase 2 prospective study. Results: Among the 40 patients studied, 4 (10%) experienced local recurrence, and among these, 2 also had simultaneous distant relapses. Node recurrence was identified in 2 patients (5%), and 4 patients (10%) had distant failures. Local recurrence within the radiation treatment area was noted in 2 patients (5%), while 2 others experienced recurrence outside the treatment area. Treatments administered included stereotactic body radiotherapy (SBRT) for one patient, salvage surgery for another, and palliative care for the two patients with concurrent distant metastases. The median survival time after recurrence was 12.1 months, with an interquartile range (IQR) of 10 to 14.1 months. Conclusion: Although the application of IGBT in the treatment of cervical cancer led to commendable local control and disease-free survival rates, the most common failure mode observed was distant relapse.