Alina Sturdza - Academia.edu (original) (raw)

Papers by Alina Sturdza

Radiotherapy and Oncology, Aug 1, 2021

Radiotherapy and Oncology, Mar 1, 2013

Journal of Contemporary Brachytherapy, 2021

Purpose: Clinical drawings are integral part of image-guided adaptive brachytherapy (IGABT) of ce... more Purpose: Clinical drawings are integral part of image-guided adaptive brachytherapy (IGABT) of cervical cancer. It was used in EMBRACE study protocol as a useful tool. In our study clinical drawings from EMBRACE study were modified to include scales in all the dimensions for more accurate representation of various tumor related volumes. The aim of the present study was to understand patterns of tumor regression and relationship between gross tumor at diagnosis (GTVD) and high-risk clinical target volume (CTV-T HR)/intermediate-risk clinical target volume (CTV-T IR) in brachytherapy (BRT), using modified clinical drawings. Material and methods: 42 cervical cancer patients, staged as FIGO IIB-IIIB according to EMBRACE study, were enrolled. Advanced schematic 3D mapping diagram (3D-MD) in axial, coronal, and sagittal orientations, with a measurement scale (grid with 10 mm distance) for precise assessment and documentation was applied (through MRI at diagnosis and during brachytherapy). Dimensions, including height, width, and thickness as well as volumes (GTVD, CTV-T HR and CTV-T IR) were compared both qualitatively and quantitatively. Results and conclusions: We found qualitative and quantitative correlation of the dimensions of final CTV-T HR with initial GTVD. Meticulous mapping of tumor volumes can provide useful insights to CTV-T HR volume during brachytherapy.

Brachytherapy, May 1, 2016

International Journal of Radiation Oncology Biology Physics, Jul 1, 2023

Journal of Clinical Oncology, Apr 1, 2023

PURPOSE To report clinical and treatment characteristics, remission and failure patterns, and ris... more PURPOSE To report clinical and treatment characteristics, remission and failure patterns, and risk factors for local failure (LF) from the EMBRACE-I study. MATERIALS AND METHODS EMBRACE-I was a prospective, observational, multicenter cohort study on magnetic resonance imaging–based image-guided adaptive brachytherapy (MR-IGABT) in locally advanced cervical cancer. Treatment consisted of external beam radiotherapy, concurrent chemotherapy, and MR-IGABT. LF was defined as progressive or recurrent disease in the cervix, uterus, parametria, pelvic wall, or vagina. Competing risk analysis was used to estimate local tumor control (LC) and Cox proportional regression models for multivariable analysis and dose-response analysis. RESULTS One thousand three hundred eighteen patients with a median follow-up of 52 months were available for this analysis. Eighty-one patients had persistent disease 3 months after end of treatment. Of those, 60 patients achieved LC at 6-9 months without further treatment, whereas 21 patients had progressive disease. In addition, 77 patients developed a local recurrence after complete remission comprising a total number of 98 LFs. LFs were located inside the MR-IGABT target volumes in 90% of patients with LF. In multivariable analysis, histology, minimal dose to 90% of high-risk clinical target volume (CTVHR), maximum tumor dimension, CTVHR > 45 cm3, overall treatment time, tumor necrosis on magnetic resonance imaging at diagnosis, uterine corpus infiltration at diagnosis and at MR-IGABT, and mesorectal infiltration at MR-IGABT had significant impact on LF. Dose-response analysis showed that a minimal dose to 90% of 85 Gy to the CTVHR led to 95% (95% CI, 94 to 97) LC 3 years postintervention for squamous cell in comparison to 86% (95% CI, 81 to 90) for adeno/adenosquamous carcinoma histology. CONCLUSION The present study demonstrates the safety and validity of the GYN GEC-ESTRO/ICRU-89 target concept and provides large-scale evidence for dose prescription and new risk factors for LF in MR-IGABT in locally advanced cervical cancer.

International Journal of Radiation Oncology*Biology*Physics, 2022

PURPOSE A simple scoring system (T-score, TS) for integrating findings from clinical examination ... more PURPOSE A simple scoring system (T-score, TS) for integrating findings from clinical examination and MRI of the primary tumor at diagnosis has shown strong prognostic capability for predicting local control and survival in locally advanced cervical cancer (LACC) treated with chemoradiation and MRI guided brachytherapy (BT). The aim was to validate the performance of TS using the multicenter XXXX study and to evaluate the prognostic implications of TS regression obtained during initial chemoradiation. MATERIALS AND METHODS XXXX recruited 1416 patients of which 1318 were available for TS. Patients were treated with chemoradiation followed by MRI guided BT. A ranked ordinal scale of 0-3 points was used to assess 8 anatomic locations typical for local invasion of cervical cancer. TS was calculated separately at diagnosis (TSD) and at BT (TSBT) by the sum of points obtained from the 8 locations at the two occasions. RESULTS Median TSD and TSBT was 5 and 4, respectively. TS regression was observed in 71% and was an explanatory variable for BT technique (intracavitary vs intracavitary/interstitial) and major dose volume histogram parameters for BT such as CTVHR, CTVHR D90, D2cm3 bladder and D2cm3 rectum. TS regression (TSBT≤5) was associated with improved local control and survival and with less morbidity compared to patients with TSBT remaining high (>5) despite initial chemoradiation. TS-regression was significant in multivariate analysis for both local control and survival when analyzed in consort with already established prognostic parameters related to the patient, disease and treatment. CONCLUSION TS was validated in a multicenter setting and proven to be a strong multidisciplinary platform for integration of clinical findings and imaging with the ability to quantitate local tumor regression and its prognostic implications with regard to BT technique, DVH parameters, local control, survival and morbidity.

Strahlentherapie Und Onkologie, 2014

Radiotherapy and Oncology, 2020

Radiotherapy and Oncology, 2020

Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, 2021

Radiotherapy and Oncology, 2021

Radiotherapy and Oncology, 2021

OBJECTIVE To assess risk factors for nodal failure (NF) after definitive (chemo)radiotherapy and ... more OBJECTIVE To assess risk factors for nodal failure (NF) after definitive (chemo)radiotherapy and image-guided brachytherapy for locally advanced cervical cancer (LACC) for patients treated in the EMBRACE I study. MATERIALS AND METHODS Data for pelvic NF and para-aortic (PAO) NF (NFPAO) were analysed. After multiple imputation, univariable and multivariable Cox-regression was performed for clinical and treatment-related variables. For patients with affected pelvic nodes but no PAO nodes at diagnosis, additional analyses were performed for two subgroups: 1. 'small pelvis' nodes in internal and external iliac, obturator, parametrial, presacral and/or common iliac (CI) region and 2. any CI nodes (subgroup of 1). RESULTS 1338 patients with 152 NF and 104 NFPAO events were analysed with a median follow-up of 34.2 months (IQR 16.4-52.7). For the entire group, larger tumour width, nodal risk groups (in particular any CI nodes without PAO nodes), local failure, and lower Hb-nadir increased the risk of NF. Elective PAO-irradiation was independently associated with a decreased risk of NFPAO (HR 0.53, 95%-CI 0.28-1.00, p=0.05). For subgroup 1, having 'any CI nodes without PAO nodes' and local failure significantly increased NF risk. Additionally, elective PAO-irradiation was associated with less risk of NFPAO (HR 0.38, 95%-CI 0.17-0.86, p=0.02). For subgroup 2 only local failure was associated with higher risk of NF. CONCLUSION In this patient cohort, nodal disease and tumour width at diagnosis, as well as local failure, are risk factors for NF after definitive treatment. Having either 'any PAO nodes' (with or without pelvic nodes) or 'any CI nodes' (without PAO nodes) are stronger risk factors than involvement of nodes in the small pelvis alone. Elective PAO-irradiation was associated with significantly less NFPAO, particularly in patients with nodal disease in the 'small pelvis' and/or CI region at time of diagnosis.

Radiotherapy and Oncology, 2020

International Journal of Radiation Oncology*Biology*Physics, 2021

OBJECTIVE To evaluate patient-reported sexual outcomes following chemoradiotherapy and image-guid... more OBJECTIVE To evaluate patient-reported sexual outcomes following chemoradiotherapy and image-guided adaptive brachytherapy for locally advanced cervical cancer (LACC) in the observational, prospective, multi-center XXXX-study. METHODS Sexual outcomes were prospectively assessed with EORTC-QLQ-CX24 questionnaire at baseline and follow-up. Crude incidence and prevalence rates of sexual activity, vaginal functioning problems (dryness, shortening, tightening, pain during intercourse) and sexual enjoyment were evaluated. Associations between pain during intercourse and vaginal functioning problems/sexual enjoyment were calculated, pooling observations over all follow-ups (Spearman correlation coefficient). In patients who were frequently sexually active (≥50% of follow-ups), the impact of regular hormonal replacement therapy (HRT) on vaginal functioning problems was evaluated (Pearson Chi-square). RESULTS 1045 patients were analyzed with a median follow-up of 50 months. Sexual activity was reported by 22% of patients at baseline and by 40-47% during follow-up (prevalence rates). Vaginal functioning problems in follow-up were ranging between 18-21% (dryness), 15-22% (shortening), 16-22% (tightening), 9-21% (pain during intercourse), 37-47% (compromised enjoyment). Pain during intercourse was significantly associated with vaginal tightening (r=0.544), shortening (r=0.532), dryness (r=0.408) and negatively correlated with sexual enjoyment (r=-0.407). Regular HRT was associated with significantly less vaginal dryness (p=0.015), shortening (p=0.024), pain during intercourse (p=0.003) and borderline higher sexual enjoyment (p=0.062). CONCLUSION Vaginal functioning problems are associated with pain and compromised sexual enjoyment. Further efforts are required for primary prevention of vaginal morbidity with dose optimization and adaptation. Secondary prevention strategies, including HRT for vaginal/sexual health after radiotherapy in LACC should be considered and sexual rehabilitation programs should be further developed.

Radiotherapy and Oncology, 2021

The Lancet Oncology, 2021

BACKGROUND The concept of the use of MRI for image-guided adaptive brachytherapy (IGABT) in local... more BACKGROUND The concept of the use of MRI for image-guided adaptive brachytherapy (IGABT) in locally advanced cervical cancer was introduced 20 years ago. Here, we report on EMBRACE-I, which aimed to evaluate local tumour control and morbidity after chemoradiotherapy and MRI-based IGABT. METHODS EMBRACE-I was a prospective, observational, multicentre cohort study. Data from patients from 24 centres in Europe, Asia, and North America were prospectively collected. The inclusion criteria were patients older than 18 years, with biopsy-proven squamous cell carcinoma, adenocarcinoma, or adenosquamous carcinoma of the uterine cervix, The International Federation of Gynecology and Obstetrics (FIGO) stage IB-IVA disease or FIGO stage IVB disease restricted to paraaortic lymph metastasis below the L1-L2 interspace, suitable for curative treatment. Treatment consisted of chemoradiotherapy (weekly intravenous cisplatin 40 mg/m2, 5-6 cycles, 1 day per cycle, plus 45-50 Gy external-beam radiotherapy delivered in 1·8-2 Gy fractions) followed by MRI-based IGABT. The MRI-based IGABT target volume definition and dose reporting was according to Groupe Européen de Curiethérapie European Society for Radiation Oncology recommendations. IGABT dose prescription was open according to institutional practice. Local control and late morbidity were selected as primary endpoints in all patients available for analysis. The study was registered with ClinicalTrials.gov, NCT00920920. FINDINGS Patient accrual began on July 30, 2008, and closed on Dec 29, 2015. A total of 1416 patients were registered in the database. After exclusion for not meeting patient selection criteria before treatment, being registered but not entered in the database, meeting the exclusion criteria, and being falsely excluded, data from 1341 patients were available for analysis of disease and data from 1251 patients were available for assessment of morbidity outcome. MRI-based IGABT including dose optimisation was done in 1317 (98·2%) of 1341 patients. Median high-risk clinical target volume was 28 cm3 (IQR 20-40) and median minimal dose to 90% of the clinical target volume (D90%) was 90 Gy (IQR 85-94) equi-effective dose in 2 Gy per fraction. At a median follow-up of 51 months (IQR 20-64), actuarial overall 5-year local control was 92% (95% CI 90-93). Actuarial cumulative 5-year incidence of grade 3-5 morbidity was 6·8% (95% CI 5·4-8·6) for genitourinary events, 8·5% (6·9-10·6) for gastrointestinal events, 5·7% (4·3-7·6) for vaginal events, and 3·2% (2·2-4·5) for fistulae. INTERPRETATION Chemoradiotherapy and MRI-based IGABT result in effective and stable long-term local control across all stages of locally advanced cervical cancer, with a limited severe morbidity per organ. These results represent a positive breakthrough in the treatment of locally advanced cervical cancer, which might be used as a benchmark for clinical practice and all future studies. FUNDING Medical University of Vienna, Aarhus University Hospital, Elekta AB, and Varian Medical Systems.

E-Poster discussions, 2019

Brachytherapy, 2019

Purpose: Prostate brachytherapy with iodine-125 permanent seed implantation (BT) started in Japan... more Purpose: Prostate brachytherapy with iodine-125 permanent seed implantation (BT) started in Japan in 2003. More than 3400 cases were performed at our institute during the past 15 years. Long term outcomes of BT and it's predictors of recurrence were analyzed.

Radiotherapy and Oncology, 2019

Radiotherapy and Oncology, Aug 1, 2021

Radiotherapy and Oncology, Mar 1, 2013

Journal of Contemporary Brachytherapy, 2021

Purpose: Clinical drawings are integral part of image-guided adaptive brachytherapy (IGABT) of ce... more Purpose: Clinical drawings are integral part of image-guided adaptive brachytherapy (IGABT) of cervical cancer. It was used in EMBRACE study protocol as a useful tool. In our study clinical drawings from EMBRACE study were modified to include scales in all the dimensions for more accurate representation of various tumor related volumes. The aim of the present study was to understand patterns of tumor regression and relationship between gross tumor at diagnosis (GTVD) and high-risk clinical target volume (CTV-T HR)/intermediate-risk clinical target volume (CTV-T IR) in brachytherapy (BRT), using modified clinical drawings. Material and methods: 42 cervical cancer patients, staged as FIGO IIB-IIIB according to EMBRACE study, were enrolled. Advanced schematic 3D mapping diagram (3D-MD) in axial, coronal, and sagittal orientations, with a measurement scale (grid with 10 mm distance) for precise assessment and documentation was applied (through MRI at diagnosis and during brachytherapy). Dimensions, including height, width, and thickness as well as volumes (GTVD, CTV-T HR and CTV-T IR) were compared both qualitatively and quantitatively. Results and conclusions: We found qualitative and quantitative correlation of the dimensions of final CTV-T HR with initial GTVD. Meticulous mapping of tumor volumes can provide useful insights to CTV-T HR volume during brachytherapy.

Brachytherapy, May 1, 2016

International Journal of Radiation Oncology Biology Physics, Jul 1, 2023

Journal of Clinical Oncology, Apr 1, 2023

PURPOSE To report clinical and treatment characteristics, remission and failure patterns, and ris... more PURPOSE To report clinical and treatment characteristics, remission and failure patterns, and risk factors for local failure (LF) from the EMBRACE-I study. MATERIALS AND METHODS EMBRACE-I was a prospective, observational, multicenter cohort study on magnetic resonance imaging–based image-guided adaptive brachytherapy (MR-IGABT) in locally advanced cervical cancer. Treatment consisted of external beam radiotherapy, concurrent chemotherapy, and MR-IGABT. LF was defined as progressive or recurrent disease in the cervix, uterus, parametria, pelvic wall, or vagina. Competing risk analysis was used to estimate local tumor control (LC) and Cox proportional regression models for multivariable analysis and dose-response analysis. RESULTS One thousand three hundred eighteen patients with a median follow-up of 52 months were available for this analysis. Eighty-one patients had persistent disease 3 months after end of treatment. Of those, 60 patients achieved LC at 6-9 months without further treatment, whereas 21 patients had progressive disease. In addition, 77 patients developed a local recurrence after complete remission comprising a total number of 98 LFs. LFs were located inside the MR-IGABT target volumes in 90% of patients with LF. In multivariable analysis, histology, minimal dose to 90% of high-risk clinical target volume (CTVHR), maximum tumor dimension, CTVHR > 45 cm3, overall treatment time, tumor necrosis on magnetic resonance imaging at diagnosis, uterine corpus infiltration at diagnosis and at MR-IGABT, and mesorectal infiltration at MR-IGABT had significant impact on LF. Dose-response analysis showed that a minimal dose to 90% of 85 Gy to the CTVHR led to 95% (95% CI, 94 to 97) LC 3 years postintervention for squamous cell in comparison to 86% (95% CI, 81 to 90) for adeno/adenosquamous carcinoma histology. CONCLUSION The present study demonstrates the safety and validity of the GYN GEC-ESTRO/ICRU-89 target concept and provides large-scale evidence for dose prescription and new risk factors for LF in MR-IGABT in locally advanced cervical cancer.

International Journal of Radiation Oncology*Biology*Physics, 2022

PURPOSE A simple scoring system (T-score, TS) for integrating findings from clinical examination ... more PURPOSE A simple scoring system (T-score, TS) for integrating findings from clinical examination and MRI of the primary tumor at diagnosis has shown strong prognostic capability for predicting local control and survival in locally advanced cervical cancer (LACC) treated with chemoradiation and MRI guided brachytherapy (BT). The aim was to validate the performance of TS using the multicenter XXXX study and to evaluate the prognostic implications of TS regression obtained during initial chemoradiation. MATERIALS AND METHODS XXXX recruited 1416 patients of which 1318 were available for TS. Patients were treated with chemoradiation followed by MRI guided BT. A ranked ordinal scale of 0-3 points was used to assess 8 anatomic locations typical for local invasion of cervical cancer. TS was calculated separately at diagnosis (TSD) and at BT (TSBT) by the sum of points obtained from the 8 locations at the two occasions. RESULTS Median TSD and TSBT was 5 and 4, respectively. TS regression was observed in 71% and was an explanatory variable for BT technique (intracavitary vs intracavitary/interstitial) and major dose volume histogram parameters for BT such as CTVHR, CTVHR D90, D2cm3 bladder and D2cm3 rectum. TS regression (TSBT≤5) was associated with improved local control and survival and with less morbidity compared to patients with TSBT remaining high (>5) despite initial chemoradiation. TS-regression was significant in multivariate analysis for both local control and survival when analyzed in consort with already established prognostic parameters related to the patient, disease and treatment. CONCLUSION TS was validated in a multicenter setting and proven to be a strong multidisciplinary platform for integration of clinical findings and imaging with the ability to quantitate local tumor regression and its prognostic implications with regard to BT technique, DVH parameters, local control, survival and morbidity.

Strahlentherapie Und Onkologie, 2014

Radiotherapy and Oncology, 2020

Radiotherapy and Oncology, 2020

Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, 2021

Radiotherapy and Oncology, 2021

Radiotherapy and Oncology, 2021

OBJECTIVE To assess risk factors for nodal failure (NF) after definitive (chemo)radiotherapy and ... more OBJECTIVE To assess risk factors for nodal failure (NF) after definitive (chemo)radiotherapy and image-guided brachytherapy for locally advanced cervical cancer (LACC) for patients treated in the EMBRACE I study. MATERIALS AND METHODS Data for pelvic NF and para-aortic (PAO) NF (NFPAO) were analysed. After multiple imputation, univariable and multivariable Cox-regression was performed for clinical and treatment-related variables. For patients with affected pelvic nodes but no PAO nodes at diagnosis, additional analyses were performed for two subgroups: 1. 'small pelvis' nodes in internal and external iliac, obturator, parametrial, presacral and/or common iliac (CI) region and 2. any CI nodes (subgroup of 1). RESULTS 1338 patients with 152 NF and 104 NFPAO events were analysed with a median follow-up of 34.2 months (IQR 16.4-52.7). For the entire group, larger tumour width, nodal risk groups (in particular any CI nodes without PAO nodes), local failure, and lower Hb-nadir increased the risk of NF. Elective PAO-irradiation was independently associated with a decreased risk of NFPAO (HR 0.53, 95%-CI 0.28-1.00, p=0.05). For subgroup 1, having 'any CI nodes without PAO nodes' and local failure significantly increased NF risk. Additionally, elective PAO-irradiation was associated with less risk of NFPAO (HR 0.38, 95%-CI 0.17-0.86, p=0.02). For subgroup 2 only local failure was associated with higher risk of NF. CONCLUSION In this patient cohort, nodal disease and tumour width at diagnosis, as well as local failure, are risk factors for NF after definitive treatment. Having either 'any PAO nodes' (with or without pelvic nodes) or 'any CI nodes' (without PAO nodes) are stronger risk factors than involvement of nodes in the small pelvis alone. Elective PAO-irradiation was associated with significantly less NFPAO, particularly in patients with nodal disease in the 'small pelvis' and/or CI region at time of diagnosis.

Radiotherapy and Oncology, 2020

International Journal of Radiation Oncology*Biology*Physics, 2021

OBJECTIVE To evaluate patient-reported sexual outcomes following chemoradiotherapy and image-guid... more OBJECTIVE To evaluate patient-reported sexual outcomes following chemoradiotherapy and image-guided adaptive brachytherapy for locally advanced cervical cancer (LACC) in the observational, prospective, multi-center XXXX-study. METHODS Sexual outcomes were prospectively assessed with EORTC-QLQ-CX24 questionnaire at baseline and follow-up. Crude incidence and prevalence rates of sexual activity, vaginal functioning problems (dryness, shortening, tightening, pain during intercourse) and sexual enjoyment were evaluated. Associations between pain during intercourse and vaginal functioning problems/sexual enjoyment were calculated, pooling observations over all follow-ups (Spearman correlation coefficient). In patients who were frequently sexually active (≥50% of follow-ups), the impact of regular hormonal replacement therapy (HRT) on vaginal functioning problems was evaluated (Pearson Chi-square). RESULTS 1045 patients were analyzed with a median follow-up of 50 months. Sexual activity was reported by 22% of patients at baseline and by 40-47% during follow-up (prevalence rates). Vaginal functioning problems in follow-up were ranging between 18-21% (dryness), 15-22% (shortening), 16-22% (tightening), 9-21% (pain during intercourse), 37-47% (compromised enjoyment). Pain during intercourse was significantly associated with vaginal tightening (r=0.544), shortening (r=0.532), dryness (r=0.408) and negatively correlated with sexual enjoyment (r=-0.407). Regular HRT was associated with significantly less vaginal dryness (p=0.015), shortening (p=0.024), pain during intercourse (p=0.003) and borderline higher sexual enjoyment (p=0.062). CONCLUSION Vaginal functioning problems are associated with pain and compromised sexual enjoyment. Further efforts are required for primary prevention of vaginal morbidity with dose optimization and adaptation. Secondary prevention strategies, including HRT for vaginal/sexual health after radiotherapy in LACC should be considered and sexual rehabilitation programs should be further developed.

Radiotherapy and Oncology, 2021

The Lancet Oncology, 2021

BACKGROUND The concept of the use of MRI for image-guided adaptive brachytherapy (IGABT) in local... more BACKGROUND The concept of the use of MRI for image-guided adaptive brachytherapy (IGABT) in locally advanced cervical cancer was introduced 20 years ago. Here, we report on EMBRACE-I, which aimed to evaluate local tumour control and morbidity after chemoradiotherapy and MRI-based IGABT. METHODS EMBRACE-I was a prospective, observational, multicentre cohort study. Data from patients from 24 centres in Europe, Asia, and North America were prospectively collected. The inclusion criteria were patients older than 18 years, with biopsy-proven squamous cell carcinoma, adenocarcinoma, or adenosquamous carcinoma of the uterine cervix, The International Federation of Gynecology and Obstetrics (FIGO) stage IB-IVA disease or FIGO stage IVB disease restricted to paraaortic lymph metastasis below the L1-L2 interspace, suitable for curative treatment. Treatment consisted of chemoradiotherapy (weekly intravenous cisplatin 40 mg/m2, 5-6 cycles, 1 day per cycle, plus 45-50 Gy external-beam radiotherapy delivered in 1·8-2 Gy fractions) followed by MRI-based IGABT. The MRI-based IGABT target volume definition and dose reporting was according to Groupe Européen de Curiethérapie European Society for Radiation Oncology recommendations. IGABT dose prescription was open according to institutional practice. Local control and late morbidity were selected as primary endpoints in all patients available for analysis. The study was registered with ClinicalTrials.gov, NCT00920920. FINDINGS Patient accrual began on July 30, 2008, and closed on Dec 29, 2015. A total of 1416 patients were registered in the database. After exclusion for not meeting patient selection criteria before treatment, being registered but not entered in the database, meeting the exclusion criteria, and being falsely excluded, data from 1341 patients were available for analysis of disease and data from 1251 patients were available for assessment of morbidity outcome. MRI-based IGABT including dose optimisation was done in 1317 (98·2%) of 1341 patients. Median high-risk clinical target volume was 28 cm3 (IQR 20-40) and median minimal dose to 90% of the clinical target volume (D90%) was 90 Gy (IQR 85-94) equi-effective dose in 2 Gy per fraction. At a median follow-up of 51 months (IQR 20-64), actuarial overall 5-year local control was 92% (95% CI 90-93). Actuarial cumulative 5-year incidence of grade 3-5 morbidity was 6·8% (95% CI 5·4-8·6) for genitourinary events, 8·5% (6·9-10·6) for gastrointestinal events, 5·7% (4·3-7·6) for vaginal events, and 3·2% (2·2-4·5) for fistulae. INTERPRETATION Chemoradiotherapy and MRI-based IGABT result in effective and stable long-term local control across all stages of locally advanced cervical cancer, with a limited severe morbidity per organ. These results represent a positive breakthrough in the treatment of locally advanced cervical cancer, which might be used as a benchmark for clinical practice and all future studies. FUNDING Medical University of Vienna, Aarhus University Hospital, Elekta AB, and Varian Medical Systems.

E-Poster discussions, 2019

Brachytherapy, 2019

Purpose: Prostate brachytherapy with iodine-125 permanent seed implantation (BT) started in Japan... more Purpose: Prostate brachytherapy with iodine-125 permanent seed implantation (BT) started in Japan in 2003. More than 3400 cases were performed at our institute during the past 15 years. Long term outcomes of BT and it's predictors of recurrence were analyzed.

Radiotherapy and Oncology, 2019