VIBE - Virtual Image Guided Brachytherapy Emulation for Locally Advanced Cervical Cancer (LACC)

This is a phase I/II feasibility study of hypofractionated, image-guided Volumetric Modulated Arc Therapy (VMAT) Stereotactic Body Radiotherapy (SBRT) to LACC with the aim to reproduce HDR BT dose distribution by means of external beam radiotherapy in the radical treatment in patients with LACC. The study will employ devices to accurately reproduce pelvic anatomy and mitigate target motion and will make use of real-time online tracking.

Eligible patients who consent to participate in the current study will receive 4 image-guided SBRT sessions to a prescription of 7 Gray per fraction to the LACC (HR-CTV) following whole pelvis external beam radiotherapy.

SBRT will start within one week after whole pelvis external beam radiotherapy. The study will enroll a total of 30 patients. After treatment, patients will be followed-up at 1 month, at 3 months (+/- 1 week), at 6 months (+/- 4 weeks), and then every 6 months (+/- 6 weeks) until the end of the 3rd year, then annually until the 5th year.

The equivalence of outcome and toxicity will be measured by comparing the data obtained in the study to literature data regarding the standard modality of brachytherapy. Patients' oncological outcomes, toxicity and quality of life data will be reported.

Inclusion criteria

• Cancer of the uterine cervix suitable for curative treatment with definitive radio-chemotherapy
• Biopsy proven showing squamous-cell carcinoma, adenocarcinoma or adeno-squamous cell carcinoma of the uterine cervix.
• Pelvic MRI.
• MRI and Positron emission tomography (PET-CT) of the retroperitoneal space and abdomen at diagnosis is performed.
• Stage IIB to IVA according to International Federation of Gynecological and Obstetrics (FIGO) and TNM guidelines.
• Planning MRI with the applicator in place for the SBRT boost.
• Para-aortic metastatic nodes below L1-L2 are allowed.
• Study specific signed patient informed consent.

Exclusion criteria

• Other primary malignancies except carcinoma in situ of the cervix and basal cell carcinoma of the skin.
• Small cell neuroendocrine cancer, melanoma and other rare cancers in the cervix.
• Metastatic disease above and beyond the retroperitoneal paraaortic L1-L2 interspace.
• Previous pelvic or abdominal radiotherapy.
• Previous total or partial hysterectomy.
• Contra-indications to MRI.
• Severe psychiatric condition.
• Severe, active co-morbidity.