UNICURE-HD: A Multicentric retrospective cohort study of Single-Insertion Image-Guided HDR Brachytherapy for Locally Advanced Cervical Cancer in the context of Limited Brachytherapy access in France.
retrospective_cohort · Level III
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- Also identified by DOI 10.1016/j.ijrobp.2026.04.022.
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Abstract
To assess feasibility, early outcomes, and toxicity of single-implant IGABT for LACC in a multicenter French cohort; a pragmatic strategy to address limited and uneven access to uterovaginal IGABT while preserving disease control and treatment safety. We retrospectively analyzed 363 consecutive patients (FIGO 2009 IB-IVA) treated with concurrent chemoradiation consisting of pelvic ± para-aortic IMRT/VMAT (45 Gy in 25 fractions) with nodal boost to involved lymph nodes when indicated, followed by one applicator insertion delivering 4 HDR fractions. Planning was MRI-guided with applicator in place when available, otherwise CT-guided with rigid fusion to an MRI performed few days before. Composite doses were converted to equivalent doses per 2 Gy fractions, as per linear quadratic model. Outcomes (local control [LC], nodal and distant control, overall survival [OS], disease-free survival [DFS]) were estimated by Kaplan-Meier from end of radiotherapy. Severe late toxicity was CTCAE v5.0 grade ≥3. T2b was the predominant T stage (59.5%), with nodal involvement in 47.9% of patients. The median overall treatment time (OTT) was 56 days (IQR 50-61). Median D90-CTV<sub>HR</sub> was 85.9 Gy<sub>EQD2</sub> (IQR 80.4-91.6 Gy<sub>EQD2</sub>). At a median follow-up of 20.2 months (range: 1.6-121 months), the Kaplan-Meier-estimated 3-year local control rate was 83.1% (95% CI 76.4-88.0). At 36 months, LC was higher with MRI-centered than CT-MRI fusion planning (93.5% [85.7-97.2] vs 78.5% [70.4-84.6]) on unadjusted Kaplan-Meier. LC rate were 94% for patients with an OTT <50 days, 89% for those with an OTT of 50-55 days, and 81% for patients with an OTT >55 days. Overall, grade ≥3 toxicity events occurred in 14.0% of the cohort. In this multicenter real-world cohort, local control was high overall particularly among patients treated with MRI-centered, applicator-in-place brachytherapy planning. Single-implant HDR-IGABT for LACC was feasible, providing outcomes broadly consistent with historical multi-insertion series in terms of side effects. Longer follow-up and expanded accrual will refine durability and prognostic analyses.