Gyn brachy

Question 1

What percentage of risk of fistula at 3 years associated with D2cc(Rectum)>=75Gy(EMBRACE trial)

Answer 1

12.5%

Question 2

What percentage of risk of fistula at 3 years associated with D2cc(Rectum)<75Gy(EMBRACE trial)

Answer 2

0-2.7%

Question 3

How many fold reduction in risk of proctitis associated with D2cc<65Gy than >=65Gy(EMBRACE trial)

Answer 3

2 folds

Question 4

RetroEMBRACE trial

IGBT in LACC: Improved pelvic control and survival

Answer 4

Retrospective observational cohort study including 12 institutions worldwide

731 patients
Median follow up 43 months

3/5 year actuarial
LC(IB,IIB,IIIB) 98/98%,93/91%,79/75%
PC(IB,IIB,IIIB) 96/96%,89/87%,73/67%
CSS 79/73%
OS 74/65%

5 year G3-G5 morbidity
Bladder 5%
GI 7%
Vagina 5%

Question 5

RetroEMBRACE trial

IGABT combined IC+IS technique improves therapeutic ratio in LACC

Answer 5

IC+IS D90 of CTV-HR increased from 
83 +_14Gy to 92+_13Gy(p<0.01)
No difference in dose to OARs 
3 years LC for CTV-HR >30cm3 was 91% and <=30cm3 was >96%, 10% higher in IC+IS
No difference was found in <=30cm3

Question 6

EMBRACE data has demonstrated dose to ICRU recto-vaginal point correlate to what grade of vaginal morbidity?

Answer 6

G>=2 vaginal morbidity

Question 7

Phase III Adjuvant and Neo-adjuvant chemotherapy trial in locally advanced cervical cancer to address improve systemic control

Answer 7

OUTBACK trial

INTERLACE trial

Question 8

retroEMBRACE trial overall treatment time(OTT) EBRT+IGABT

Answer 8

7 weeks

Question 9

retroEMBRACE trial effect of OTT shortening by 1 week equivalent to?

Answer 9

Escalating CTV-HR dose by 5Gy(D90) resulting in increase local control by 1% for CTV-HR volume 20cm3, 1.2% for 30cm3, 2.5% for 70cm3

Question 10

EMBRACE trial dose constrain bladder during IGBT

Answer 10

D2cc>80Gy EQD2 clinically significant increase in >=G2 morbidity
Bladder events Frequency, Urgency, Cystitis

Question 11

EMBRACE trial dose constraint for rectum during IGBT

Answer 11

D2cc>70-75Gy there is steep increase in risk of rectal bleeding

Question 12

EMBRACE trial dose constraint sigmoid/bowel during IGBT

Answer 12

D2cc assessment in sigmoid/bowel in highly uncertain due to mobility
In case of adherence, D2cc>60-70Gy

Question 13

EMBRACE trial dose constraint for vaginal wall during IGBT

Answer 13

D2cc ~ 65Gy vaginal stenosis 20%
D2cc ~ 75Gy vaginal stenosis 27%
Occurred within first 18 months

Question 14

EMBRACE trial elective PAN irradiation

Answer 14

Para-arotic failures contributed with 69% of all nodal failures with strongest predictor being pelvic nodal disease at time of diagnosis