ESGO-ESTRO-ESP guidelines for the management of patients with endometrial carcinoma: update 2025.

In 2023, based on advances in the understanding of the pathological and molecular features of endometrial carcinoma, an updated International Federation of Gynaecology and Obstetrics (FIGO) staging system was published, aiming to better define prognostic groups and identify relevant treatment subgroups by including factors reflecting tumour biology (histological subtypes, lymphovascular space invasion, and molecular classification) alongside refinements of anatomical factors (peritoneal carcinomatosis and lymph node metastasis). As part of its mission to improve the quality of care for people with gynaecological cancers, the European Society of Gynaecological Oncology (ESGO), European Society for Radiotherapy and Oncology (ESTRO), and the European Society of Pathology (ESP) updated the ESGO-ESTRO-ESP evidence-based guidelines published in 2021 by incorporating this revised FIGO staging and the large body of new evidence addressing the management of endometrial carcinoma. The development process of these guidelines was based on a systematic literature review and critical appraisal process involving an international multidisciplinary development group consisting of 30 experts from relevant disciplines (gynaecological oncology, radiation oncology, medical oncology, and pathology).

NTCP models based on CT-guided online adaptive SBRT for abdominal lymph node oligometastases.

Background And Purpose: This study prospectively analyzed the correlation between dose and toxicity in CT-guided online adaptive stereotactic body radiotherapy for abdominal and pelvic lymph node (A-P LN) oligometastases. The aim was to design an NTCP model to predict acute gastrointestinal (GI) toxicity.

Materials And Methods: Patients with oligometastatic A-P LN received 45 Gy in five fractions.

Rule-based AI automated adaptive treatment planning for image guided cervical cancer brachytherapy.

Background And Purpose: A rule-based AI system for automated adaptive treatment planning for image guided adaptive brachytherapy (IGABT) of locally advanced cervical cancer (LACC) was developed at Erasmus MC, and internally and externally validated by Erasmus MC and Tata Memorial Centre (TMC), respectively.

Materials And Methods: The BiCycle system generates automated plans with adapted requirements for each fraction, considering previously delivered external beam radiotherapy (EBRT) and BT doses, according EMBRACE-II protocol. It optimizes dosimetric parameters and loading patterns for available radioactive source positions.

Prospective evaluation of AI-based BiCycle autoplanning for advanced cervical cancer brachytherapy.

Background And Purpose: Rule-based AI BiCycle autoplanning compared favorably with manual planning in retrospective planning studies. In this study, we prospectively evaluated BiCycle's 'real life' impact by running it in parallel to current manual planning. Apart from dosimetric evaluations, treating physicians scored plans, and planning times were recorded.

Afterloader integrated EMT enables improved dwell position model definition and quality assurance in Venezia gynaecological brachytherapy applicators.

In brachytherapy for gynecological cancers using intracavitary applicators, implant reconstruction is commonly performed using applicator libraries. These libraries contain applicator geometry models as well as dwell position (DP) models defined in respect to the applicator geometry. In this study, we investigate whether an afterloader integrated electromagnetic tracking (EMT) system can be utilized for DP model definition and quality assurance in such applicators.

Distant Metastasis After Chemoradiation and Image Guided Adaptive Brachytherapy in Locally Advanced Cervical Cancer.

Purpose: This study aimed to assess patterns and risks of distant metastasis (DM) in patients with cervical cancer treated with chemoradiation therapy and MR-image guided adaptive brachytherapy (IGABT) and to explore a potential dose-effect relationship of concomitant cisplatin.

Methods And Materials: Data were derived from EMBRACE I, an international, prospective, and multicenter cohort study conducted at 24 centers across Europe, Asia, and North America from July 30, 2008, to December 29, 2015. The study included 1416 patients with biopsy-confirmed cervical cancer (International Federation of Gynecology and Obstetrics [FIGO] stage IB-IVA or stage IVB limited to paraaortic lymph nodes below the L1/L2 interspace).

Pattern of recurrence of the molecular subgroups in stage I high-grade endometrial cancer.

Objective: Patterns of recurrence may impact the possibilities for salvage treatment and prognosis of patients with endometrial carcinoma (EC). We evaluated the recurrence rate and distribution pattern of the molecular EC subgroups in patients with stage I high-grade disease without adjuvant treatment and those staged by lymphadenectomy.

Method: 412 high-grade EC from the Danish Gynecological Cancer Database were molecularly profiled and classified into POLE mutant (POLEmut), mismatch repair deficient (MMRd), p53-abnormal (p53abn) or no specific molecular profile (NSMP) EC.

Reducing Number of Treatment Fractions for Patients With Abdominal Lymph Node Oligometastases: The Need for Online Adaptive Radiation Therapy to Provide Personalized Adaptive Fractionation.

Purpose: The aim of this in silico trial was to explore using online adaptive radiation therapy (OART) for isotoxic personalized fractionation and in-treatment dose adaptation for patients with abdominal-pelvic lymph node oligometastases. We hypothesized that this method could significantly reduce treatment fractions, increase treatment capacity, and improve patient comfort.

Methods And Materials: Twenty patients with abdominal-pelvic lymph node metastases from a phase 2 study (STEAL, NL58442.

Computed Tomography Guided Online Adaptive Stereotactic Body Radiation Therapy for Lymph Node Oligometastases: Impact on Dose to Target and Organs at Risk.

Purpose: This study investigates the radiation dose in abdominal and pelvic lymph node oligometastases (A-P LN) and gastrointestinal organs (GIOs) of patients undergoing computed tomography (CT) guided online adaptive stereotactic body radiation therapy in a phase 2 study. The study aimed to increase the dose to the target iso-toxically.

Methods And Materials: Patients with oligometastatic A-P LN received 45 Gy in 5 fractions on the CyberKnife.

Defining the Optimal Radiation-induced Lymphopenia Metric to Discern Its Survival Impact in Esophageal Cancer.

Purpose: A detrimental association between radiation-induced lymphopenia (RIL) and oncologic outcomes in patients with esophageal cancer has been established. However, an optimal metric for RIL remains undefined but is important for the application of this knowledge in clinical decision-making and trial designs. The aim of this study was to find the optimal RIL metric discerning survival.

Results of a Single-Arm Phase 2 Clinical Trial: Online Adaptive Stereotactic Body Radiation Therapy for Abdominal-Pelvic Oligometastases.

Purpose: This study reports on the clinical outcomes of the single-arm phase-2 STEAL trial investigating online adaptive stereotactic body radiation therapy (SBRT) for abdominal-pelvic lymph node (A-P LN) oligometastases.

Methods And Materials: Patients with oligometastatic A-P LN were enrolled and treated to a total dose of 45 Gy in 5 fractions on the CyberKnife. For each patient, a library of 3 plans was created using a pretreatment diagnostic computed tomography (CT) scan and the treatment planning CT scan.

Cost-effectiveness of a nurse-led sexual rehabilitation intervention for women treated with radiotherapy for gynaecological cancer in a randomized trial.

Purpose: To compare the cost-effectiveness of a nurse-led sexual rehabilitation intervention with standard care in women treated with external beam radiotherapy, with or without brachytherapy, for gynaecological cancers.

Methods: Eligible women were randomly assigned to the intervention (n = 112) or standard care (n = 117). Primary endpoint was sexual functioning at 12-months post-radiotherapy, assessed by the Female Sexual Function Index (FSFI).

Margin and robustness settings for a library-of-plans IMPT strategy for locally advanced cervical cancer.

This study aims to determine a margin and robustness setting for treating locally advanced cervical cancer (LACC) with a library-of-plans (LoP) based online-adaptive intensity-modulated proton therapy (IMPT).We analyzed 13 LACC patients with delineated planning and weekly repeat CT scans (reCTs). For each patient, 120 IMPT treatments of 25 fractions were simulated with a LoPs approach.

Retinoblastoma Protein Loss in p53 Abnormal Endometrial Carcinoma: Histologic and Clinicopathological Correlates.

Of the 4 molecular subtypes of endometrial cancer (EC), p53-abnormal (p53abn) EC is associated with abundant copy number alterations and the worst clinical outcome. Patients with p53abn EC have the highest risk of disease recurrence and death, independent of tumor grade and histologic subtype. Currently, all invasive p53abn ECs are considered high risk, and no prognostic biomarkers have yet been found that can aid in clinical management.

Stereotactic body radiation therapy on abdominal-pelvic lymph node oligometastases: a systematic review on toxicity.

Background And Purpose: To review available data on toxicity during and/or after treatment of abdominal-pelvic lymph node oligometastases (A-P LN) with stereotactic body radiation therapy (SBRT) and to provide an overview of adverse events and its relation to dose or fractionation.

Material And Methods: For this systematic review, we searched MEDLINE, Embase, Web of Science Core Collection, and CINAH for studies published between the database inception and October 3rd, 2023. Inclusion criteria were (1) patients with 1-5 A-P LN oligometastases, (2) treatment with SBRT to a median prescribed dose of ≥55 Gy BED10, and (3) description of acute and/or late toxicity.

Automated planning of curved needle channels in 3D printed patient-tailored applicators for cervical cancer brachytherapy.

Patient-tailored intracavitary/interstitial (IC/IS) brachytherapy (BT) applicators may increase dose conformity in cervical cancer patients. Current configuration planning methods in these custom applicators rely on manual specification or a small set of (straight) needles. This work introduces and validates a two-stage approach for establishing channel configurations in the 3D printed patient-tailored ARCHITECT applicator.

Personalized strategies for brachytherapy of cervix cancer.

Among most tailored approaches in radiation oncology, the development of brachytherapy for the treatment of cervical cancer patients has benefited from various technological innovations. The development of 3D image-guided treatments was the first step for treatment personalization. This breakthrough preceded practice homogenization and validation of predictive dose and volume parameters and prognostic factors.

Association Between the Regular Use of Vaginal Dilators and/or Sexual Activity and Vaginal Morbidity in Locally Advanced Cervical Cancer Survivors: An EMBRACE-I Study Report.

Purpose: The purpose of this study was to provide risk estimations for vaginal morbidity with regard to vaginal dilation (summarizing the use of dilators and/or sexual activity) in patients with locally advanced cervical cancer treated with definitive radiochemotherapy and image guided adaptive brachytherapy within the prospective, multi-institutional EMBRACE-I study.

Methods And Materials: Physician-assessed vaginal morbidity (National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0), use of vaginal dilators, and patient-reported sexual activity (EORTC-CX24) were prospectively assessed at baseline and during regular follow-ups.

Gynecological brachytherapy hybrid training: The Tata Memorial Centre and BrachyAcademy experience.

Purpose: The lack of training is a significant barrier to practicing brachytherapy (BT). Tata Memorial Centre, alongside international BT experts and BrachyAcademy, developed a hybrid gynecological BT training module. This study outlines the preparation, organization, and execution of the 2022-2023 Mumbai training, evaluates its effectiveness, and highlights areas for improvement.

Assessment of integrated electromagnetic tracking for dwell position monitoring in a clinical HDR brachytherapy setting for prostate cancer.

Background: Electromagnetic Tracking (EMT) technology has been integrated in a prototype high-dose-rate brachytherapy (HDR-BT) afterloading device. Its potential for dwell position (DP) monitoring has earlier been demonstrated in prostate phantoms. However, its performance for prostate BT in the clinical setting remains to be assessed.

Biomarker Expression and Clinical Outcomes in International Study of Chemoradiation and Magnetic Resonance Imaging-Based Image-Guided Brachytherapy for Locally Advanced Cervical Cancer: BIOEMBRACE.

Purpose: BIOEMBRACE was designed to study the impact of biomarkers in addition to clinicopathological factors on disease outcomes in patients treated with chemoradiation and magnetic resonance imaging (MRI)-guided brachytherapy (BT) for locally advanced cervical cancer in the EMBRACE study.

Methods And Materials: Between 2018 and 2021, 8 EMBRACE-I sites contributed tumor tissue for the immunohistochemistry of p16, PD-L1, and L1CAM. These biomarkers and clinicopathological factors (International Federation of Gynecology and Obstetrics 2009 stage, nodal status, histology, and necrosis on MRI) were analyzed to predict poor response at BT (high-risk clinical target volume [HR-CTV] ≥ 40 cc) at BT) and 5-year local control, pelvic control, and disease-free survival.