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Background <p>This study aimed to evaluate clinical outcomes in patients with vaginal recurrences treated with radiotherapy with or without chemotherapy, followed by image-guided interventional radiotherapy (IG-IRT).</p> Methods <p>We retrospectively analyzed patients with vaginal recurrences treated with external beam radiotherapy (EBRT) ± chemotherapy followed by endovaginal high dose rate IG-IRT. The EBRT total dose was 45&#xa0;Gy. The interventional radiotherapy boost delivered 28&#xa0;Gy in four high-dose-rate fractions, achieving 85–95&#xa0;Gy EQD2 (α/β 10) to the high-risk clinical target volume and 60&#xa0;Gy EQD2 (α/β 10) to the intermediate-risk clinical target volume. The primary endpoint was local control. Secondary endpoints included metastasis-free survival, overall survival, cancer-specific survival, and acute and late toxicities.</p> Results <p>Thirty-two patients (median age, 54&#xa0;years) were included. Two-year actuarial local control, metastasis-free survival, overall survival, and cancer-specific survival rates were 100%, 77.8%, 93%, and 93%, respectively. At univariate analysis, chemotherapy was significantly associated with a reduced risk of metastasis (<i>p</i> = 0.0038). Among chemotherapy regimens, cisplatin-based therapy showed the lowest metastatic risk, with metastases occurring in 5% of patients (<i>p</i> = 0.019). Age &gt; 59&#xa0;years was significantly associated with increased mortality (<i>p</i> = 0.026). At multivariate analysis, age was the only independent predictor of mortality (<i>p</i> &lt; 0.05). Acute grade 2 gastrointestinal and skin toxicity occurred in two patients, while one patient experienced late grade 3 vaginal stenosis.</p> Conclusions <p>Image-guided interventional radiotherapy as a boost following EBRT for vaginal cuff recurrences is an effective and safe treatment option, providing excellent local control with a favourable toxicity profile.</p>

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Image-guided adaptive interventional radiotherapy (modern brachytherapy) boost for vaginal recurrences

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年6月20日

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  • Valentina Lancellotta,
  • Maria Concetta La Milia,
  • Enrico Rosa,
  • Pierpaolo Dragonetti,
  • Bruno Fionda,
  • Leonardo Bannoni,
  • Rosa Autorino,
  • Alessia Nardangeli,
  • Francesca Tortoreto,
  • Benedetta Gui,
  • Luca Russo,
  • Angeles Rovirosa,
  • Alessio Giuseppe Morganti,
  • Gabriella Macchia,
  • Maria Antonietta Gambacorta,
  • Luca Tagliaferri

摘要

Background

This study aimed to evaluate clinical outcomes in patients with vaginal recurrences treated with radiotherapy with or without chemotherapy, followed by image-guided interventional radiotherapy (IG-IRT).

Methods

We retrospectively analyzed patients with vaginal recurrences treated with external beam radiotherapy (EBRT) ± chemotherapy followed by endovaginal high dose rate IG-IRT. The EBRT total dose was 45 Gy. The interventional radiotherapy boost delivered 28 Gy in four high-dose-rate fractions, achieving 85–95 Gy EQD2 (α/β 10) to the high-risk clinical target volume and 60 Gy EQD2 (α/β 10) to the intermediate-risk clinical target volume. The primary endpoint was local control. Secondary endpoints included metastasis-free survival, overall survival, cancer-specific survival, and acute and late toxicities.

Results

Thirty-two patients (median age, 54 years) were included. Two-year actuarial local control, metastasis-free survival, overall survival, and cancer-specific survival rates were 100%, 77.8%, 93%, and 93%, respectively. At univariate analysis, chemotherapy was significantly associated with a reduced risk of metastasis (p = 0.0038). Among chemotherapy regimens, cisplatin-based therapy showed the lowest metastatic risk, with metastases occurring in 5% of patients (p = 0.019). Age > 59 years was significantly associated with increased mortality (p = 0.026). At multivariate analysis, age was the only independent predictor of mortality (p < 0.05). Acute grade 2 gastrointestinal and skin toxicity occurred in two patients, while one patient experienced late grade 3 vaginal stenosis.

Conclusions

Image-guided interventional radiotherapy as a boost following EBRT for vaginal cuff recurrences is an effective and safe treatment option, providing excellent local control with a favourable toxicity profile.