e17516 Background: Concurrent chemoradiation is the standard treatment for locally advanced cervical cancer (LACC). Treatments such as interstitial brachytherapy, immune checkpoint inhibitors, or systemic chemotherapy are often added in combination to reduce tumor burden; however, these are often inaccessible to patients in low- and middle-income countries, elderly patients, or those with high-risk factors for hematologic toxicity. This study investigates whether a precise paracervical boost delivered via simultaneous integrated boost (SIB) can improve oncologic outcomes without increasing toxicity. Methods: Patients with FIGO 2018 stage IIB-IV LACC and an ECOG performance status of 0–1 were retrospectively included. All received definitive concurrent chemoradiotherapy. The paracervical boost was delivered via SIB to 60 Gy, combined with conventional pelvic radiotherapy (50.4 Gy in 28 fractions of 1.8 Gy) using volumetric modulated arc therapy (VMAT), followed by high-dose-rate brachytherapy. Dose-volume parameters for targets (CTV parametrium) and organs at risk (bladder, rectum, bowel) were evaluated. The primary endpoint was 6-month disease-free survival (DFS). Secondary endpoints included treatment response and late toxicity (graded by CTCAE v5.0). Results: Until January 10, 2026, 41 patients were enrolled, with a median age of 60.5 years (IQR 49–67). Stage distribution was: IIB in 5 (12.20%), IIIA in 1 (2.44%), IIIB in 3 (7.32%), IIIC1r in 21 (51.22%), IIIC2r in 7 (17.07%), and IV in 4 (9.76%). Histology was squamous carcinoma in 97.56% and adenocarcinoma in 2.44%. All patients received CCRT, with 20 (48.78%) receiving ipsilateral SIB and 21 (51.22%) receiving bilateral SIB. Among 37 patients who completed radiotherapy, imaging evaluation at 1 month showed complete remission in 35 (94.59%) and partial remission in 2 (5.41%). After a median follow-up of 6 months, 3 patients had relapsed (2 with lung metastasis, 1 with multiple muscle metastases). Nineteen patients had follow-up >6 months, with a 6-month DFS rate of 94.73%. Grade II radiation proctitis occurred in 3 patients (7.32%); no grade III/IV adverse events were observed. Conclusions: A tailored paracervical boost using SIB represents a promising treatment option for patients with locally advanced cervical cancer. These results warrant further validation with longer follow-up and a larger sample size.
Wang et al. (Thu,) studied this question.