Brachytherapy for cervical cancer does not increase the risk of ureteral stricture

April 21, 2018, European Society for Radiotherapy and Oncology

A rare but potentially serious complication following radiation treatment for cervical cancer is a narrowing of the tube (the ureter) that takes urine from the kidneys to the bladder, which can lead to kidney damage and sometimes life-threatening infections. This is called ureteral stricture and, until now, there have been concerns that brachytherapy might increase the risk, although the treatment itself is associated with better survival.

However, new research presented at the ESTRO 37 conference today (Saturday) from two large international trials, shows that intracavitary and interstitial (IC/IS) is safe and does not increase the of ureteral stricture. Intracavitary (IC) brachytherapy involves placing an applicator in the uterus, while interstitial (IS) brachytherapy involves inserting needles directly into the tumour. Then the appropriate radiation dose is delivered to the cancer via one or both of these approaches. The procedure is performed after a CT or MRI scan has pinpointed the exact position of the cancer, so that the can be targeted precisely, and this is called image-guided brachytherapy (IGBT).

Dr Lars Fokdal (MD, PhD), a consultant at the Aarhus University Hospital, Denmark, who led the study, said: "These results show that image-guided brachytherapy using intracavitary combined with interstitial techniques is safe and is not associated with more cases of ureteral stricture afterwards compared to using intracavitary techniques alone."

Dr Fokdal and his colleagues looked at data from 1772 patients with that had started to spread to nearby tissues (locally advanced) who were enrolled in two trials of the treatment - EMBRACE and retro-EMBRACE - that were being carried out in 12 countries. IC/IS IGBT was delivered to 36% of the patients.

After following the patients for between one and 163 months (the middle or 'median' number of months was 29), 36 patients were diagnosed with the more severe form of ureteral stricture (grade 3-4). The overall risk of developing grade 3-4 ureteral stricture was 2% after three years and 3.2% after five years. The risk was lowest (1.3%) among the 1370 patients with small tumours, and highest among the 130 patients with more advanced cancer and who had ureters swollen due to a build-up of urine (hydronephrosis) at the time of diagnosis. In these patients the risk of ureteral stricture was 13.6% after three years and 23.4% after five years.

"The incidence of ureteral stricture in cervical cancer patients generally is between 2-3%, so the overall risk of developing the complication after IC/IS image-guided brachytherapy compares well. It is good to know that the interstitial component of IGBT does not increase the risk of this relatively rare but sometimes serious complication. However, the risk is more pronounced in patients with advanced stage and hydronephrosis at diagnosis," said Dr Fokdal.

"There are different strategies that can be used to avoid ureteral stricture in the subset of patients who are at higher risk. One strategy could be closer observation following IC/IS IGBT so that ureteral strictures could be spotted earlier before they become too severe. Another strategy could be insertion of ureteral stents before radiotherapy in order to visualise the organ on imaging and reduce the dose delivered during brachytherapy."

He continued: "Results from the retro-EMBRACE and EMBRACE trials have also shown that IC/IS image-guided brachytherapy is associated with a better outcome for patients in terms of survival and adverse side-effects. The increased, but targeted radiation dose to the tumour controls the cancer better without adversely affecting nearby organs and tissues. Taking all these results together, we have growing evidence in favour of IC/IS IGBT for treating cervical cancer."

Symptoms of a ureteral stricture include back pain, loss of kidney function and a risk of severe kidney or urinary tract infection. It is treated either by widening the blocked tube and inserting a stent to keep it open or by inserting a tube directly into the kidney through the skin that is connected to a urine collection bag secured to the patient's back. Some patients will need this for a short time, but for some it may be permanent.

President of ESTRO, Professor Yolande Lievens, head of the department of radiation oncology at Ghent University Hospital, Belgium, said: "These results from the EMBRACE and retro-EMBRACE trials provide reassuring evidence on the benefits of combining interstitial and intracavitary brachytherapy to treat cervical patients. While the study showed that patients who are at higher risk of complications can be identified, thus allowing us to monitor them more closely and maybe use a slightly different treatment approach to decrease their risk, it also clearly illustrated that using the latest technology translates into better outcomes and value for our ."

Explore further: Combined brachytherapy techniques should be 'benchmark' for cervical cancer treatment

More information: Abstract no: OC-0072, "Risk factors for ureteral stricture after IGABT in cervical cancer: results from the EMBRACE studies", Gynaecological brachytherapy session at 10.30 hrs (CEST) on Saturday 21 April, Room 129-130.

Related Stories

Combined brachytherapy techniques should be 'benchmark' for cervical cancer treatment

April 24, 2015
The first large international study to investigate the late side-effects of a combination of two forms of brachytherapy to treat cervical cancer has shown that the technique successfully delivers higher radiation doses to ...

Brachytherapy rather than surgery is a good option for cancer of the penis

May 8, 2017
Results from the largest group of men treated for cancer of the penis by a single institution have shown that treatment with brachytherapy (a type of radiotherapy) is a good option that can be used instead of surgery in many ...

International trial confirms safety, effectiveness of HDR brachytherapy for cervical cancer

September 25, 2017
Findings from a new multicenter, international clinical trial confirm the effectiveness of high-dose brachytherapy, or internal radiation therapy, for managing locally advanced cervical cancer. Tumor control was significantly ...

A gold-standard cancer treatment is in decline, and money may be why

December 12, 2017
The evidence is clear: Cervical cancer is best treated with brachytherapy, a form of radiation therapy. Yet the use of this potentially lifesaving treatment has been declining, and a new study from the University of Virginia ...

Giving a single, high dose of radiation directly to the site of a prostate tumor is safe

May 6, 2017
Doctors have found that treating prostate cancer with a single, high dose of radiation delivered precisely to the site of the tumour results in good quality of life and fewer trips to the hospital, with adverse side effects ...

Brachytherapy to treat cervical cancer declines in US, treatment associated with higher survival

September 11, 2013
A study by researchers at Brigham and Women's Hospital (BWH) found that brachytherapy treatment was associated with better cause-specific survival and overall survival in women with cervical cancer. The population-based analysis ...

Recommended for you

Scientists discover chemical which can kill glioblastoma cells

August 15, 2018
Aggressive brain tumour cells taken from patients self-destructed after being exposed to a chemical in laboratory tests, researchers have shown.

Three scientists share $500,000 prize for work on cancer therapy

August 15, 2018
Tumors once considered untreatable have disappeared and people previously given months to live are surviving for decades thanks to new therapies emerging from the work of three scientists chosen to receive a $500,000 medical ...

PARP inhibitor improves progression-free survival in patients with advanced breast cancers

August 15, 2018
In a randomized, Phase III trial led by researchers at The University of Texas MD Anderson Cancer Center, the PARP inhibitor talazoparib extended progression-free survival (PFS) and improved quality-of-life measures over ...

New clues into how 'trash bag of the cell' traps and seals off waste

August 15, 2018
The mechanics behind how an important process within the cell traps material before recycling it has puzzled scientists for years. But Penn State researchers have gained new insight into how this process seals off waste, ...

RUNX proteins act as regulators in DNA repair, study finds

August 15, 2018
A study by researchers from the Cancer Science Institute of Singapore (CSI Singapore) at the National University of Singapore has revealed that RUNX proteins are integral to efficient DNA repair via the Fanconi Anemia (FA) ...

Chemicals found in vegetables prevent colon cancer in mice

August 14, 2018
Chemicals produced by vegetables such as kale, cabbage and broccoli could help to maintain a healthy gut and prevent colon cancer, a new study from the Francis Crick Institute shows.


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.