"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 cancer 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 patients."

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