RetroEMBRACE

RetroEMBRACE is the first multi-institutional database including patients with locally advanced cervical cancer treating by means of radiochemotherapy including Image Guided Adaptive Brachytherapy(IGABT). A total of 852 patients were registered from 12 centres, 49 patients were excluded as there was no information on disease status. A further 72 patients were excluded for receiving supplementary treatments (neo-adjuvant/adjuvant chemotherapy or surgery as standard treatment) leaving 731 patients for analysis.

The analyses showed that IGABT combined with radio-chemotherapy leads to excellent LC (91%), PC (87%), OS (74%), CSS (79%) throughout all stages, with limited severe morbidity. IGABT shoved a trend for improved overall survival when compared to older studies on 2D BT (Sturdza et al., 2016).

In addition, target volume at the time of IGABT (CTVHRVolume) and dose to the 90% of the target volume CTVHR D90 are clear predictors for the outcome. Dose of ≥ 85Gy (D90) delivered in 7 weeks provides 3-year local control rates of >94% in limited size CTVHR (20cm3), >93% in intermediate size (30cm3) and >86% in large size (70cm3) CTVHR . CTVIR and GTVres dose of ≥ 60Gy and ≥ 95Gy (D98) lead to similar local control (Tanderup et al. 2016).

It was also proved that IC application can cover a limited target volume, while IC/IS applications allow for dose escalation to CTVHR D90, resulting in superior local control (≥ 10%) in larger tumour volume (=30 cm3 ) at the time of IGABT , without significant difference in late morbidity (Fokdal et al., 2016).

The results of RetroEMBRACE provide a benchmark for advanced clinical practice and future clinical trials in locally advanced cervical cancer, including EMBRACE II.

References:

1. Sturdza A, Pötter R, Fokdal LU, Haie-Meder C, Tan LT, Mazeron R, Petric P, Šegedin B, Jurgenliemk-Schulz IM, Nomden C, Gillham C. Image guided brachytherapy in locally advanced cervical cancer: Improved pelvic control and survival in RetroEMBRACE, a multicenter cohort study. Radiother Oncol 2016 Sep 30;120(3):428-33.
2. Fokdal L, Sturdza A, Mazeron R, Haie-Meder C, Tan LT, Gillham C, Šegedin B, Jürgenliemk-Schultz I, Kirisits C, Hoskin P, Pötter R. Image guided adaptive brachytherapy with combined intracavitary and interstitial technique improves the therapeutic ratio in locally advanced cervical cancer: Analysis from the retroEMBRACE study. Radiother Oncol 2016 Sep 30;120(3):434-40.
3. Tanderup K, Fokdal LU, Sturdza A, Haie-Meder C, Mazeron R, Van Limbergen E, Jürgenliemk-Schulz I, Petric P, Hoskin P, Dörr W, Bentzen SM. Effect of tumor dose, volume and overall treatment time on local control after radiochemotherapy including MRI guided brachytherapy of locally advanced cervical cancer. Radiother Oncol 2016 Sep 30;120(3):441-6