Journal
CLINICAL AND TRANSLATIONAL RADIATION ONCOLOGY
Volume 9, Issue -, Pages 48-60Publisher
ELSEVIER IRELAND LTD
DOI: 10.1016/j.ctro.2018.01.001
Keywords
Cervix cancer; Brachytherapy; Adaptive radiotherapy; MRI guided radiotherapy; Local control; Morbidity
Funding
- Varian Medical Systems
- Danish Cancer Society
- Elekta
- Christian Doppler Laboratory for Medical Radiation Research for Radiation Oncology (Medical University of Vienna, Austria)
- Bebig
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The publication of the GEC-ESTRO recommendations one decade ago was a significant step forward for reaching international consensus on adaptive target definition and dose reporting in image guided adaptive brachytherapy (IGABT) in locally advanced cervical cancer. Since then, IGABT has been spreading, particularly in Europe, North America and Asia, and the guidelines have proved their broad acceptance and applicability in clinical practice. However, a unified approach to volume contouring and reporting does not imply a unified administration of treatment, and currently both external beam radiotherapy (EBRT) and IGABT are delivered using a large variety of techniques and prescription/fractionation schedules. With IGABT, local control is excellent in limited and well-responding tumours. The major challenges are currently loco-regional control in advanced tumours, treatment-related morbidity, and distant metastatic disease. Emerging evidence from the RetroEMBRACE and EMBRACE I studies has demonstrated that clinical outcome is related to dose prescription and technique. The next logical step is to demonstrate excellent clinical outcome with the most advanced EBRT and brachytherapy techniques based on an evidence-based prospective dose and volume prescription protocol. The EMBRACE II study is an interventional and observational multicentre study which aims to benchmark a high level of local, nodal and systemic control while limiting morbidity, using state of the art treatment including an advanced target volume selection and contouring protocol for EBRT and brachytherapy, a multi-parametric brachytherapy dose prescription protocol (clinical validation of dose constraints), and use of advanced EBRT (IMRT and IGRT) and brachytherapy (IC/IS) techniques (clinical validation). The study also incorporates translational research including imaging and tissue biomarkers. (C) 2018 The Authors. Published by Elsevier B.V. on behalf of European Society for Radiotherapy and Oncology.
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