Objective: Inadequate radiation delivery to recurrent pelvic and abdominal tumors is frequently attributable to the dose limitations of surrounding normal structures, particularly the intestines. Radiotherapy guided by magnetic resonance imaging (MRI) significantly enhances the accuracy of soft-tissue delineation. The purposes of this study were to demonstrate the feasibility and effectiveness of MR-Linac Adaptive stereotactic body radiotherapy in patients with pelvic-abdominal recurrent or metastatic gynecological malignancies with or without systemic therapies. Methods: Patients with pelvic-abdominal recurrent or metastatic gynecological malignancies are eligible for MR-Linac Adaptive stereotactic body radiotherapy. Systemic therapies, including chemotherapy, immunotherapy, and targeted therapy, are considered acceptable treatment options. The safety, tolerability, and efficacy of MR-Linac Adaptive stereotactic body radiotherapy were assessed. Results: Between October 2019 and May 2025, 15 patients were subjected to MR-Linac Adaptive stereotactic body radiotherapy. With a median follow-up period of 4.67 months (range, 0.73-20.10 months), the 6-month overall survival (OS), progression-free survival (PFS), and local control (LC) rates were 93.3%, 66.0%, and 92.3%, respectively. The 12-month OS, PFS, and LC rates were 83.8%, 37.7%, and 70.5%, respectively. The best objective response rate (ORR = CR + PR) for the irradiated lesions was 73.3% (11/15 patients). MR-Linac Adaptive stereotactic body radiotherapy led to objective responses in 73.3% (11/15) of the patients. As of the data cutoff (28 May 2025), one patient experienced dose-limiting toxicity (an enteric fistula). Another patient developed grade 4 thrombocytopenia during treatment; it was considered chemotherapy-induced. Conclusions: These findings suggest that MR-Linac Adaptive stereotactic body radiotherapy is relatively effective and safe and can be an important treatment option for patients with pelvic-abdominal recurrent or metastatic gynecological malignancies. MR-Linac Adaptive stereotactic body radiotherapy exhibited acceptable tolerability, promising efficacy, and a favorable local control rate with regard to heavily pretreated advanced solid tumors.

Objective: This study aimed to elucidate the association between hematologic toxicity (HT) and pelvic bone marrow (PBM) dosimetric parameters in patients with cervical cancer (CC) undergoing radiotherapy (RT) combined with artificial intelligence (AI)-assisted organ at risk (OAR) delineation (Software Copyright Registration Number 2023SR0150365). Accurate delineation of bone marrow (BM) regions and analysis of radiation doses may provide a theoretical foundation for the application of AI in predicting HT. Methods: This retrospective study included 141 patients with CC who received chemotherapy (sequential or concurrent) and/or pelvic volumetric modulated arc therapy (VMAT) at the Department of Gynecology, Cancer Hospital of the Chinese Academy of Medical Sciences, between March 2019 and December 2019. PBM and its subregions (ilium, lower pelvis, lumbosacral spine, and femoral heads) were delineated using AI-based automatic segmentation of CT images. The volumes receiving 10-40 Gy (V10, V20, V30, V40) were calculated, and baseline clinical characteristics were assessed. HT endpoints included grade ≥ 2 (HT2+) and grade ≥ 3 (HT3+) leukopenia, neutropenia, anemia, or thrombocytopenia. Associations between dosimetric parameters and HT were evaluated using logistic regression models. Results: Of the 141 patients, 107 (75.8%) developed HT2+ and 33 (23.4%) developed HT3+. Univariate analysis showed that chemotherapy and age were correlated with HT2+. Multivariate analysis identified femoral head V30, femoral head V40, and chemotherapy as independent predictors of HT3+. Conclusions: This study highlights the potential of AI-based OAR delineation for assessing PBM dosimetric parameters in patients with CC. Optimizing RT to minimize BM dose and volume may mitigate HT and enhance treatment tolerance. In our cohort, receipt of combined neoadjuvant and concurrent chemotherapy (NACT+CCRT) was a stronger predictor of HT than most BM dosimetric parameters, suggesting that the systemic effect of chemotherapy may dominate the hematologic toxicity profile in this setting. Consequently, patients receiving this combined modality treatment are at particularly high risk for HT and warrant close hematologic monitoring.

5521 Background: Cervical cancer ranks as the fourth most common cancer, with 32% of cases being locally advanced (stage IIB-IVA, LACC). The standard treatment is concurrent chemoradiotherapy (CCRT) with platinum drugs, but many patients only achieve partial or short-term remission. Nimotuzumab has shown promise in treating LACC, but few studies focus on high-risk cases (FIGO 2018 III-IVA). This study aims to evaluate the efficacy and safety of combining nimotuzumab with CCRT for high-risk LACC. (NCT06771596). Methods: Patients aged 18-75 with confirmed cervical squamous cell carcinoma, an ECOG status of 0-2, and at least one measurable lesion were eligible. All patients received nimotuzumab 400 mg weekly for 4-6 weeks combined with CCRT. CCRT included external beam radiotherapy (45 Gy/1.8Gy/25 fractions) using volumetric modulated arc therapy (VMAT), concurrent with weekly cisplatin (40mg/m 2 for 4-6 weeks), followed by image-guided high-dose-rate brachytherapy, aiming for a cumulative dose ≥87 Gy (EQD2). The primary endpoint was 1-, 2-year progression free survival (PFS) per RECIST 1.1. The secondary endpoints were 1-, 2-year overall survival (OS), objective response rate (ORR), disease control rate (DCR) rate per RECIST v1.1, and safety per CTCAE v5.0. Results: In total, 40 patients were enrolled. The baseline characteristics are shown in the table. 36 (90%) patients had CR, 3 (7.5%) patients had PR, ORR was 97.5% (95% CI: 86.84%-99.94%), and DCR was 97.5% (95% CI: 86.84%-99.94%). The median follow-up time was 21.32 months (95% CI: 20.01~24.34) months, with mPFS and mOS not yet reached. The 1-, 2-year PFS rates were 79.11% (95% CI: 62.53%-88.97%) and 76.29% (95% CI: 59.33%-86.91%), respectively, and 1-, 2-year OS rate were 100% (95% CI: 100%~100%) and 85.27% (95% CI: 64.8%~94.32%). The most common AEs were leukopenia (42.5%), myelosuppression (40%), and anemia (37.5%), all of which were graded 1-2. Conclusions: Nimotuzumab combined with chemoradiotherapy in the treatment of high-risk squamous LACC demonstrated prolonged PFS and favorable safety profile. Clinical trial information: NCT06771596 . Baseline characteristics. Characteristic All patients (n=40) Age (mean ± SD, years) 53.9±11.69 FIGO stage IIIA-IIIB 6(15.0%) IIIC1R-IIIC2R 33(82.5%) IVA 1(2.5%) Tumor differentiation Low differentiation 8(20.0%) Medium differentiation 1(2.5%) Highly differentiation 31(77.5%)

Background and purpose:In current clinical practice, independent treatment plan optimization for each fraction of brachytherapy might not be able to fully leverage the dosimetric advantage of the cervical cancer radiotherapy combining external beam radiotherapy (EBRT) and brachytherapy (BT). This study proposed an offline adaptive planning method based on accumulated dose for BT, aiming to improve the total dose distribution of the combined radiotherapy. Methods and materials:This study retrospectively reviewed nine cervical cancer patients treated with EBRT followed by high-dose-rate BT. For each BT fraction, we used a multi-metric deformable image registration method to accumulate the dose distributions of previously delivered EBRT and BT. The accumulated dose distribution was then imported into a customized commercial BT treatment planning system as a background in the adaptive dose optimization. Main dosimetric parameters of the target and organs at risk (OARs) were compared between the adaptive BT (ABT) and conventional BT (CBT) planning methods. Results:For approximately 70 % of the BT fractions, the ABT plans have lower D2cc to the bladder or rectum compared with the CBT plans. In terms of total dose evaluation, the ABT planning method resulted in a decrease in mean values of D2cc, V60 and V50 for the bladder (-1.9 ± 2.0 GyEDQ2, -1.2 ± 1.2 %, and -0.9 ± 1.1 %) and rectum (-2.1 ± 1.8 GyEQD2, -1.2 ± 1.2 %, and -1.4 ± 1.3 %). Conclusion:The offline adaptive planning method could help decrease the doses to OARs and improve the total dose distribution of combined radiotherapy, showing promising prospects for clinical use.

To investigate potential predictive factors and assess the utility of systemic inflammatory and nutritional indexes as prognostic indicators for survival in patients with FIGO stage III-IVA squamous cervical cancer (squamous HR-LACC) treated with concurrent chemoradiotherapy. We included consecutive patients with PET-CT diagnosed squamous HR-LACC undergoing curative chemoradiotherapy from November 2016 to April 2024. We systematically reviewed data pertaining to pretreatment clinicopathologic characteristics, hematological parameters, and treatment specifics. A range of composite inflammatory and nutritional indices were calculated, including the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, lymphocyte-to-monocyte ratio, systemic immune-inflammation index, systemic inflammation response index, pan-immune-inflammation value, and prognostic nutritional index (PNI). X-Tile software was utilized to establish optimal cut-off values based on progression-free survival (PFS). Both univariate and multivariate Cox regression analyses were conducted to identify factors associated with PFS and overall survival (OS). Among 157 patients (median age 55) included, 136 had lymph node involvement, and 45 had para-aortic metastasis. After a median follow-up of 35 months, 47 patients had disease progression, and 22 died, yielding 3-year PFS and OS rates of 66.2

Limited data exist on the effectiveness of concurrent chemoradiotherapy (CRT) using intensity-modulated radiation therapy (IMRT) after radical surgery in patients with node-positive early-stage cervical cancer. This study aimed to identify prognostic factors and categorize patients into risk groups for personalized adjuvant therapy. The study included consecutive patients with pathologically confirmed node-positive cervical cancer who underwent radical hysterectomy and lymphadenectomy followed by CRT from January 2013 to October 2024 at our institute. Patients with parametrial invasion or positive resection margins were excluded. All patients received modern volumetric-modulated arc therapy with platinum-based concurrent chemotherapy. Data on clinicopathologic features, treatment details, and oncologic outcomes were collected. Univariate and multivariate Cox regression analyses were conducted to identify factors associated with disease-free survival (DFS) and overall survival (OS). Patients were further stratified into distinct risk categories for recurrence based on identified prognostic factors. A total of 160 patients were included, with a median age of 44 years. The median number of lymph nodes retrieved was 33, and 11 patients presented with para-aortic lymph node metastasis (LNM). Over a median follow-up period of 39.7 months, 31 patients experienced disease progression, and 12 succumbed to the disease, yielding 3-year DFS and OS rates of 81.3

Objective: A conventional endpoint for locally advanced cervical cancer (LACC) clinical trials is overall survival (OS) with five years of follow-up. The primary hypothesis was that progression-free survival (PFS) with three years of follow-up (PFS36) would be an appropriate primary surrogate endpoint. Materials and methods: The primary hypothesis, which was developed from our data, was further investigated using phase III randomized controlled trials and then externally validated using retrospective studies up to 2023. Correlation analysis at the treatment-arm level was performed between 2-, 3-, 4-, and 5-year PFS rates and 5-year OS. Results: A total of 613 patients with histologically confirmed cervical cancer who underwent radiotherapy or chemoradiation at our institute between January 2010 and December 2013 were eligible. The recurrence rates for years 1 through 5 were 12.9%, 7.3%, 3%, 2.3%, and 1.8%, respectively. Patients who did not achieve PFS36 had a 5-year OS rate of 30.3%. However, patients who achieved PFS36 had a 5-year OS rate of 98.2%. Further data were extracted from 26 randomized phase III trials on LACC. The trials included 55 arms, with a pooled sample size of 7,281 patients. Trial-level surrogacy results revealed that PFS36 (r2, 0.732) was associated with 5-year OS. The correlation between PFS36 and OS was externally validated using independent retrospective data. Conclusion: A significant positive correlation was found between PFS36 and OS at 5 years of follow-up both within patients and across trials. These results suggest that PFS36 is an appropriate endpoint for LACC clinical trials of radiotherapy-based regimens.

PurposeDifficulties remain in dose optimization and evaluation of cervical cancer radiotherapy that combines external beam radiotherapy (EBRT) and brachytherapy (BT). This study estimates and improves the accumulated dose distribution of EBRT and BT with deep learning–based dose prediction.Materials and methodsA total of 30 patients treated with combined cervical cancer radiotherapy were enrolled in this study. The dose distributions of EBRT and BT plans were accumulated using commercial deformable image registration. A ResNet-101–based deep learning model was trained to predict pixel-wise dose distributions. To test the role of the predicted accumulated dose in clinic, each EBRT plan was designed using conventional method and then redesigned referencing the predicted accumulated dose distribution. Bladder and rectum dosimetric parameters and normal tissue complication probability (NTCP) values were calculated and compared between the conventional and redesigned accumulated doses.ResultsThe redesigned accumulated doses showed a decrease in mean values of V50, V60, and D2cc for the bladder (−3.02%, −1.71%, and −1.19 Gy, respectively) and rectum (−4.82%, −1.97%, and −4.13 Gy, respectively). The mean NTCP values for the bladder and rectum were also decreased by 0.02‰ and 0.98%, respectively. All values had statistically significant differences (p < 0.01), except for the bladder D2cc (p = 0.112).ConclusionThis study realized accumulated dose prediction for combined cervical cancer radiotherapy without knowing the BT dose. The predicted dose served as a reference for EBRT treatment planning, leading to a superior accumulated dose distribution and lower NTCP values.

Although the incidence of cervical cancer (CC) has been reduced in high-income countries due to human papillomavirus (HPV) vaccination and screening strategies, it remains a significant public health issue that poses a threat to women’s health in low-income countries. Here, we perform a comprehensive proteogenomic profiling of CC tumors obtained from 139 Chinese women. Integrated proteogenomic analysis links genetic aberrations to downstream pathogenesis-related pathways and reveals the landscape of HPV-associated multi-omic changes. EP300 is found to enhance the acetylation of FOSL2-K222, consequently accelerating the malignant proliferation of CC cells. Proteomic stratification identifies three patient subgroups with distinct features in prognosis, genetic alterations, immune infiltration, and post-translational modification regulations. PRKCB is further identified as a potential radioresponse-related biomarker of CC patients. This study provides a valuable public resource for researchers and clinicians to delve into the molecular basis of CC, to identify potential treatments and to ultimately advance clinical practice. Cervical cancer remains a significant public health problem in many regions. Here, the authors perform a proteogenomic analysis of cervical cancer in Chinese patients; they reveal proteomic subgroups associated with clinical and biological features, and a potential biomarker of response to radiotherapy.

RATIONALE:Cervical metastasis of breast cancer is rare and its clinical manifestations are similar to those of primary cervical cancer. It is thus easy to misdiagnose, with diagnosis mainly depending on pathology and immunohistochemistry. There have been few studies on its treatment and there is thus no standard treatment plan. PATIENT CONCERNS:This is a 64-year-old female patient presented with a 2-month history of abnormal postmenopausal vaginal discharge, who had previous history of breast cancer. DIAGNOSES:Based on the gynecological examination, imaging results, pathology, and immunohistochemical results, a diagnosis of metastatic carcinoma of the cervix and breast cancer was confirmed. INTERVENTIONS:She received computed tomography-guided 3-dimensional high-dose-rate brachytherapy in combination with chemotherapy. OUTCOMES:She achieved complete response locally. This case provides a new local treatment option for patients with inoperable localized cervical metastases. LESSONS:We hope that this report and the accompanying review help to enrich the literature pertaining to the treatment of rare cervical metastases, providing a foundation for the improved survival of affected patients.

PURPOSE:The purpose of this study was to evaluate the efficacy of recombinant human superoxide dismutase (rhSOD) enemas in radiation-induced acute rectal injury (RARI) in patients with locally advanced cervical cancer. METHODS AND MATERIALS:In this phase 3, randomized, open-label trial (NCT04819685) conducted across 14 medical centers in China from June 2021 to August 2023, all patients received concurrent chemoradiation therapy (CCRT). The experimental group was treated with a rhSOD enema during chemoradiation therapy, and the control group had no enema. The Common Terminology Criteria for Adverse Events (version 5.0) was used to evaluate radiation therapy-induced side effects. Endoscopic appearance was assessed using the Vienna Rectoscopy Score. The primary endpoint in the acute phase was the occurrence rate and duration of grade ≥1 (≥G1) diarrhea during CCRT. Secondary endpoints included the occurrence rate and duration of ≥G2 and ≥G3 diarrhea, ≥G1 and ≥G2 diarrhea lasting at least 3 days, and damage to the rectal mucosa due to radiation therapy measured by endoscopy. RESULTS:Two hundred and eighty-three patients were randomly divided into the experimental (n = 141) or control group (n = 142). The mean number of ≥G1 and ≥G2 diarrhea days were significantly lower in the experimental group than in the control group (3.5 and 0.8 days vs 14.8 and 4.5 days, respectively; P < .001). The incidence of ≥G2 diarrhea decreased from 53.6% to 24.1% when rhSOD enemas were used. Use of antidiarrheals was lower in the experimental group (36.2% vs 55.7%, P < .001). Three patients felt intolerable or abdominal pain after rhSOD enema. RARI grades in the experimental group tended to be lower than those in the control group (P = .061). Logistic regression analysis revealed that rhSOD enema was associated with a lower occurrence rate of ≥G1/2 diarrhea for at least 3 days (P < .001). CONCLUSIONS:The results of this study suggest that rhSOD enema is safe and significantly reduces the incidence, severity, and duration of RARI, protecting the rectal mucosa.

5534 Background: A traditional endpoint for locally advanced cervical cancer (LACC) clinical trials is overall survival with five years of follow-up (5-year OS). The use of a shorter-term endpoint could significantly speed the translation of research findings into practice. The primary hypothesis was that PFS with three years of follow-up (PFS36) is an appropriate primary endpoint to replace 5-year OS. Methods: The primary hypothesis was developed from our individual data, was further investigated using phase III randomized controlled trials (RCTs), and then externally validated by phase II trials and retrospective studies up to 2022. Correlation analysis at the treatment-arm level was performed between 2-, 3-, 4-, and 5-year PFS rates and 5-year OS. Correlation analysis was performed using the Pearson correlation coefficient r in weighted linear regression, with weight equal to patient size. The MEDLINE, Embase, and PubMed databases, together with the Cochrane Central Register of Controlled Trials, were searched from January 1, 1999, to February 2, 2023. Articles eligible for inclusion contained complete survival data. Results: A total of 613 patients with histologically confirmed, FIGO 2009 stage IB–IVA cervical cancer who underwent radiotherapy at our institute from January 2010 to December 2013 were eligible. Individual patient data were pooled to explore the correlation between PFS and the OS trend. The recurrence rates for years 1 through 5 were 12.9%, 7.3%, 3%, 2.3%, and 1.8%, respectively. The median recurrence time was 13 months and the median time from recurrence to death was 12.2 months. Within all the recurrence, 47.3% of recurrences occurred during the first year, 71.4% in the first two years, and 85% in the first three years. Patients who did not achieve PFS36 had a 5-year OS rate of 30.3%. In contrast, a 5-year OS rate of 98.2% was observed in patients who achieved PFS36. Further data were extracted from 27 randomized phase III trials on LACC. The trials included 57 arms, with a pooled sample size of 7,692 patients. In trial-level surrogacy, PFS36 (r 2 , 0.778) was associated with 5-year OS. Sensitivity analysis demonstrated reasonable overall consistency. The correlation between PFS36 and OS was externally validated using independent phase II trials and retrospective data. In total, 23 studies representing 5,174 patients were included. PFS (r 2 , 0.719) was found to be associated with 5-year OS. Conclusions: A significant correlation was found between PFS36 and 5-year OS in clinical trials on patients with locally advanced cervical cancer. This correlation was found both within patients and across trials. These results suggest that PFS36 is an appropriate endpoint for LACC trials of radiotherapy-based regimens.

(1) Purpose: Challenges remain in dose accumulation for cervical cancer radiotherapy combined with external beam radiotherapy (EBRT) and brachytherapy (BT) as there are many large and complex organ deformations between different treatments. This study aims to improve deformable image registration (DIR) accuracy with the introduction of multi-metric objectives for dose accumulation of EBRT and BT. (2) Materials and methods: Twenty cervical cancer patients treated with EBRT (45–50 Gy/25 fractions) and high-dose-rate BT (≥20 Gy in 4 fractions) were included for DIR. The multi-metric DIR algorithm included an intensity-based metric, three contour-based metrics, and a penalty term. Nonrigid B-spine transformation was used to transform the planning CT images from EBRT to the first BT, with a six-level resolution registration strategy. To evaluate its performance, the multi-metric DIR was compared with a hybrid DIR provided by commercial software. The DIR accuracy was measured by the Dice similarity coefficient (DSC) and Hausdorff distance (HD) between deformed and reference organ contours. The accumulated maximum dose of 2 cc (D2cc) of the bladder and rectum was calculated and compared to simply addition of D2cc from EBRT and BT (ΔD2cc). (3) Results: The mean DSC of all organ contours for the multi-metric DIR were significantly higher than those for the hybrid DIR (p ≤ 0.011). In total, 70% of patients had DSC > 0.8 using the multi-metric DIR, while 15% of patients had DSC > 0.8 using the commercial hybrid DIR. The mean ΔD2cc of the bladder and rectum for the multi-metric DIR were 3.25 ± 2.29 and 3.54 ± 2.02 GyEQD2, respectively, whereas those for the hybrid DIR were 2.68 ± 2.56 and 2.32 ± 3.25 GyEQD2, respectively. The multi-metric DIR resulted in a much lower proportion of unrealistic D2cc than the hybrid DIR (2.5% vs. 17.5%). (4) Conclusions: Compared with the commercial hybrid DIR, the introduced multi-metric DIR significantly improved the registration accuracy and resulted in a more reasonable accumulated dose distribution.

Objective To explore the management of high-grade neuroendocrine cervical cancer (HGNECC) since there has been no standard treatment for it. Methods Data on the management of HGNECC were retrospectively analyzed. Patients with FIGO stage IIB to IVB HGNECC from six hospitals were enrolled. The Kaplan-Meier method was used for survival analysis. Prognostic factors were determined using a Cox proportional-hazards regression model. Results A total of 43 patients were included in the study. The multivariate analysis showed that chemotherapy was the preferred treatment as it improved progression-free survival (PFS; P = 0.008) and overall survival (OS; P = 0.005). Distance metastasis was a significant negative prognostic factor for OS (P = 0.002), while radical surgery was a significant positive prognostic factor for PFS (P = 0.05). Compared with those who had received cisplatin and etoposide (>= 5 cycles), patients who had received paclitaxel plus platinum-based chemotherapy showed better PFS and OS. Five patients (two at stage IIB and three at stage IV) showed relatively long-term survival. Of these patients, four had undergone radical surgery including tumor-debulking, while three also received adjuvant chemotherapy. Conclusion Paclitaxel plus cisplatin or paclitaxel plus carboplatin may be more effective than etoposide plus cisplatin. Radical surgery followed by chemotherapy may be a favorable alternative intervention for selected patients with advanced stage cancer.

Although the prognosis of locally advanced cervical cancer has improved dramatically, survival for those with stage IIIB-IVA disease or lymph nodes metastasis remains poor. It is believed that the incorporation of intensity-modulated radiotherapy into the treatment of cervical cancer might yield an improved loco-regional control, whereas more cycles of more potent chemotherapy after the completion of concurrent chemotherapy was associated with a diminished distant metastasis. We therefore initiated a non-randomized prospective phaseII study to evaluate the feasibility of incorporating both these two treatment modality into the treatment of high risk locally advanced cervical cancer. To determine whether the incorporation of intensity-modulated radiotherapy and the addition of adjuvant paclitaxel plus cisplatin regimen into the treatment policy for patients with high risk locally advanced cervical cancer might improve their oncologic outcomes. Patients were enrolled if they had biopsy proven stage IIIA-IVA squamous cervical cancer or stage IIB disease with metastatic regional nodes. Intensity-modulated radiotherapy was delivered with dynamic multi-leaf collimators using 6MV photon beams. Prescription for PTV ranged from 45.0 50.0 Gy at 1.8 Gy 2.0 Gy/fraction in 25 fractions. Enlarged nodes were contoured separately and PTV-nodes were boosted simultaneously to a total dose of 50.0–65 Gy at 2.0- 2.6 Gy/fraction in 25 fractions. A total dose of 28 35 Gy high-dose- rate brachytherapy was prescribed to point A in 4 5 weekly fractions using an iridium- 192 source. Concurrent weekly intravenous cisplatin at 30 mg/m2 was initiated on the first day of radiotherapy for over 1-h during external-beam radiotherapy. Adjuvant chemotherapy was scheduled within 4 weeks after the completion of concurrent chemo-radiotherapy and repeated 3 weeks later. Paclitaxel 150 mg/m2 was given as a 3-h infusion on day1, followed by cisplatin 35 mg/m2 with 1-h infusion on day1-2 (70 mg/m2 in total). Fifty patients achieved complete response 4 weeks after the completion of the treatment protocol, whereas 2 patients had persistent disease. After a median follow-up period of 66 months, loco-regional (including 2 persistent disease), distant, and synchronous treatment failure occurred in 4,5, and 1, respectively. The 5-year disease-free survival, loco-regional recurrence-free survival, distant-metastasis recurrence-free survival was 80.5

AbstractPurposeTo evaluate the feasibility of a modified treatment strategy combined external beam radiation therapy (EBRT) and brachytherapy (BT) for cervical cancer through a dosimetry analysis.Material and methodsThis study retrospectively selected 12 cervical cancer patients treated with the conventional treatment strategy, which consisted of 45─50 Gy/25 fractions of EBRT using volumetric‐modulated arc therapy (VMAT) and image‐guided BT with a fraction dose of 5─7 Gy. The modified treatment strategy decreased the central EBRT dose while increasing the number of BT fractions. New target volumes were additionally contoured, and new VMAT EBRT plans were generated for the modified treatment strategy. The dosimetric parameters for evaluation included the doses to the most irradiated 2 cc (D2cc) of the organs at risk (OARs) and doses to at least 90% (D90) of the gross tumor volume (GTV) and high‐risk clinical target volume (HR‐CTV). The total doses to OARs and targets obtained by adding the equivalent doses in 2 Gy fraction (EQD2) from the EBRT and BT plans were used for quantitative comparison between the modified and conventional treatment strategies.ResultsComparison to the conventional treatment strategy, the modified treatment strategy resulted in a higher bladder D2cc, a slightly lower rectal D2cc and a similar HR‐CTV D90, all with no significant differences (p > 0.05). The GTV D90 of the modified treatment strategy was significantly higher than that of the conventional treatment strategy (p < 0.01).ConclusionThe modified treatment strategy can significantly increase the BT dose while remaining the total doses to the bladder and rectum basically unchanged, demonstrating its feasibility and promising prospect in clinical use.

Abstract Purpose To compare two inverse planning algorithms, the hybrid inverse planning optimization (HIPO) algorithm and the inverse planning simulated annealing (IPSA) algorithm, for cervical cancer brachytherapy and provide suggestions for their usage. Material and methods This study consisted of 24 cervical cancer patients treated with CT image‐based high‐dose‐rate brachytherapy using various combinations of tandem/ovoid applicator and interstitial needles. For fixed catheter configurations, plans were retrospectively optimized with two methods: IPSA and HIPO. The dosimetric parameters with respect to target coverage, localization of high dose volume (LHDV), conformal index (COIN), and sparing of organs at risk (OARs) were evaluated. A plan assessment method which combines a graphical analysis and a scoring index was used to compare the quality of two plans for each case. The characteristics of dwell time distributions of the two plans were also analyzed in detail. Results Both IPSA and HIPO can produce clinically acceptable treatment plans. The rectum D2cc was slightly lower for HIPO as compared to IPSA (P = 0.002). All other dosimetric parameters for targets and OARs were not significantly different between the two algorithms. The generated radar plots and scores intuitively presented the plan properties and enabled to reflect the clinical priorities for the treatment plans. Significant different characteristics were observed between the dwell time distributions generated by IPSA and HIPO. Conclusions Both algorithms could generate high‐quality treatment plans, but their performances were slightly different in terms of each specific patient. The clinical decision on the optimal plan for each patient can be made quickly and consistently with the help of the plan assessment method. Besides, the characteristics of dwell time distribution were suggested to be taken into account during plan selection. Compared to IPSA, the dwell time distributions generated by HIPO may be closer to clinical preference.

The purpose of this study was to investigate the clinical application of intensity-modulated radiotherapy combined with intracavitary radiotherapy for locally advanced cervical cancer complicated with uterus didelphys. We retrospectively reviewed the medical records of six patients with locally advanced cervical cancer associated with uterine malformations treated at the National Cancer Center/Cancer Hospital (Beijing, China) between 2015 and 2018. Six cases, including cervical squamous cell carcinoma (n = 3), cervical adenocarcinoma (n = 2), and clear cell adenocarcinoma (n = 1) were identified by pathological diagnosis. Uterine malformation included uterus didelphys (n = 6), with vaginal subseptum (n = 2). Six cases were treated with pelvic intensity-modulated radiotherapy. Four patients received three- dimensional intracavitary brachytherapy based on computed tomography, and two patients received conventional two-dimensional intracavitary brachytherapy. The acute and delayed responses of gastrointestinal and genitourinary toxicities were ≤grade 2 in 5 patients. Five patients achieved clinical complete remission and four patients had no recurrence during the follow-up period. One patient with cervical adenocarcinoma expired due to progression of the disease. The clinical results suggest that advanced cervical cancer associated with uterus didelphys required individual radiotherapy. The use of intensity-modulated radiotherapy combined with three-dimensional intracavitary brachytherapy is recommended in concurrent chemoradiotherapy.

子宫颈癌骨转移的发生率为2.42%，最常见的转移部位为椎骨，其次为骨盆、全身长骨，颅骨转移者少见。本文对1例发生孤立性颅骨转移的子宫颈癌患者的临床病理资料进行回顾性分析并复习相关文献。患者58岁，诊断为子宫颈鳞癌Ⅲb期，经同步放化疗后获得完全缓解。治疗结束7个月后出现头疼，诊断为孤立性颅骨转移，予局部病灶切除联合全身化疗及靶向治疗获得完全缓解。随访7个月，肿瘤无进展。提示，子宫颈癌发生孤立性颅骨转移非常罕见，头痛、头皮水肿为其典型的临床表现，正电子发射体层摄影术（PET）-CT、MRI等影像学检查有助于明确诊断及评估治疗方法。积极治疗可使子宫颈癌孤立性颅骨转移患者的生存获益。

Objective: To analyze the clinicopathological features and prognostic factors of patients with uterine clear cell carcinoma (UCCC). Methods: UCCC patients who underwent surgery and complete follow-up at Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College between January 1, 2004 and December 31, 2014 were retrospectively reviewed. The Kaplan-Meier method and Cox regression analysis were used for survival analysis. Results: The study included 34 patients. Only 18 patients (52.9%) were diagnosed with UCCC preoperatively and 8 patients (23.5%) underwent UCCC standard comprehensive staging surgery. Among the 34 patients, stage ⅠA was 17 cases (50.0%), stage ⅠB was 1 case (2.9%), stage Ⅱ was 4 cases (11.8%), stage ⅢA was 2 cases (5.9%), stage ⅢB was 1 case (2.9%), stage ⅢC1 was 5 cases (14.7%) and stage ⅣB was 4 cases (11.8%). The median follow-up period was 72 months, 5-years disease-free survival (DFS) rate and overall survival (OS) rates for all patients were 79.1% and 81.3%, respectively. Univariate analysis result showed that preoperative CA125 level, range of lymphadenectomy, tumor stage and peritoneal cytology were significantly associated with DFS (P<0.05). Preoperative CA125 level, range of lymphadenectomy, tumor stage, peritoneal cytology and lymph vascular space invasion were significantly associated with OS (P<0.05). Multivariate analysis result showed that peritoneal cytology was the only independent prognostic factor for DFS, the relapse risk of peritoneal cytology positive patients was 11.47 folds higher than that of the negative patients (P=0.009). Tumor stage was the only independent prognostic factor for OS, the death risk of ⅣB stage patients was 25.29 folds higher than that of theⅠA stage (P=0.009). Conclusions: The preoperative pathological diagnosis of UCCC is difficult, which results in incomplete surgical staging. Peritoneal cytology and tumor stage are independent prognostic factors for DFS and OS of UCCC patients, which deserve much more attention in clinical practice.