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Purpose <p>To evaluate the impact of uterine position during brachytherapy on dosimetric parameters, oncologic outcomes, and toxicity in cervical cancer patients treated with external beam radiotherapy (EBRT) followed by high-dose-rate intracavitary brachytherapy (HDR-ICBT).</p> Methods <p>A&#xa0;retrospective analysis was conducted on 278 non-metastatic cervical cancer patients treated between 2012 and 2022. All received 45–50.4 Gy EBRT followed by 28 Gy HDR-ICBT in four fractions. Uterine position was documented for each ICBT fraction, and patients with inter-fraction variations were excluded.</p> Results <p>In total, 251 patients met the inclusion criteria: 222 (88%) had an anteverted and&#xa0;29 (12%) had a&#xa0;retroverted uterus. Median follow-up was 44&#xa0;months (range: 1–134&#xa0;months). The&#xa0;2- and 5‑year overall survival rate was 82% and 71% for an anteverted vs.&#xa0;77% and 77% for a&#xa0;retroverted uterus (<i>p</i> = 0.8). Local recurrence developed in&#xa0;21 (10%) and three (11%) patients, respectively (<i>p</i> = 0.89). Median doses to the high- and intermediate-risk clinical target volumes (CTV) were higher with an anteverted uterus (91.3 vs. 89.8 Gy, <i>p</i> = 0.001; and 67.4 vs. 65.9 Gy, <i>p</i> = 0.044). A&#xa0;retroverted uterus was associated with higher rectum (76.3 vs. 79.7 Gy, <i>p</i> = 0.001) and bowel doses (66.4 vs. 73.7 Gy, <i>p</i> = 0.023), yet lower sigmoid doses (63.4 vs. 59.9 Gy, <i>p</i> = 0.005). Severe toxicity rates were similar, although late grade&#xa0;1–2 gastrointestinal toxicity was more frequent in the retroverted group (4% vs.&#xa0;17%, <i>p</i> = 0.019).</p> Conclusion <p>A&#xa0;retroverted uterine position during ICBT was associated with lower CTV doses and higher rectum and bowel doses while oncologic outcomes and severe toxicity remained comparable.</p>

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The impact of uterine position during brachytherapy on treatment outcomes and toxicity in patients with cervical cancer

  • 期刊论文

  • 发表日期：

    2026年8月3日

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  • Ecem Yigit,
  • Melis Gultekin,
  • Pantea Bayatfard,
  • Sezin Yuce Sari,
  • Fatih Biltekin,
  • Ferah Yildiz

摘要

Purpose

To evaluate the impact of uterine position during brachytherapy on dosimetric parameters, oncologic outcomes, and toxicity in cervical cancer patients treated with external beam radiotherapy (EBRT) followed by high-dose-rate intracavitary brachytherapy (HDR-ICBT).

Methods

A retrospective analysis was conducted on 278 non-metastatic cervical cancer patients treated between 2012 and 2022. All received 45–50.4 Gy EBRT followed by 28 Gy HDR-ICBT in four fractions. Uterine position was documented for each ICBT fraction, and patients with inter-fraction variations were excluded.

Results

In total, 251 patients met the inclusion criteria: 222 (88%) had an anteverted and 29 (12%) had a retroverted uterus. Median follow-up was 44 months (range: 1–134 months). The 2- and 5‑year overall survival rate was 82% and 71% for an anteverted vs. 77% and 77% for a retroverted uterus (p = 0.8). Local recurrence developed in 21 (10%) and three (11%) patients, respectively (p = 0.89). Median doses to the high- and intermediate-risk clinical target volumes (CTV) were higher with an anteverted uterus (91.3 vs. 89.8 Gy, p = 0.001; and 67.4 vs. 65.9 Gy, p = 0.044). A retroverted uterus was associated with higher rectum (76.3 vs. 79.7 Gy, p = 0.001) and bowel doses (66.4 vs. 73.7 Gy, p = 0.023), yet lower sigmoid doses (63.4 vs. 59.9 Gy, p = 0.005). Severe toxicity rates were similar, although late grade 1–2 gastrointestinal toxicity was more frequent in the retroverted group (4% vs. 17%, p = 0.019).

Conclusion

A retroverted uterine position during ICBT was associated with lower CTV doses and higher rectum and bowel doses while oncologic outcomes and severe toxicity remained comparable.