Hypofractionated Vs conventional chemoradiation in cervical cancer: 2-y results of the randomized HYPOCx-iRex trial with an exploratory pooled analysis of a single-institute EMBRACE-II cohort
Part 1
HYPO: 44 Gy/20# n=21
CVRT: 45 Gy/25# n=19
FIGO IB–IIB: 35%
FIGO IIIB–IV: 65%
Humbly and Proudly present our “Early Results of HYPOCx-iRex Trial 44Gy/20F CCRT” https://t.co/YjtqmAlEC3
The work through my medical student and residency years @SirirajRadOnco
Kudos to exceptional mentorship of PiWin (Pittaya @kuppashiryu) and PiTonn (Wiwatchai).
Thank you @ClinOncology for publication
Thank you @gusviani and @roxboxfix, for recognizing our works.
Reported at 19-mo median FU
💡Potential superior LRC, especially nodal control and hopefully OS (Not powered to answer this question)
☢️HYPO 44Gy/20F +/- SIB boost to 53 and 55Gy in 20F for gross LN
☢️Standard EMBRACE-II MRI-guided brachy deliver 8Gyx4F: Median D90 HR-CTV = 90Gy
☢️Extended PAN field HYPO was successfully performed in 2 patients, recruited after the positive result of interim analysis.
💊Standard concurrent chemotherapy scheme: wkly Cis 40mg/m2 x 5 cycles
🕑OTT sig reduced to 39 days!
🕐Time to brachy sig reduced to 29 days without compromising PreBT response (Waterfall plot)
💊Adjuvant chemo is allowed without sig diff between arms.
All without ICI (also none at adjuvant/palliative at recurrence) or induction chemo.
👁🗨Higher Acute GI toxicity but resolved at 1 month after treatment. As seen in HRQoL.
👁🗨A trend of non-sig higher Late GI Tox.
👁🗨No difference in GU Tox.
A work in progress to improve the protocol for future Phase III multicenter trial in Thailand!
Updated cost-effectiveness analysis in 2-yr follow up will be presented in Poster #ASTRO2025
29Sep 10.45am No. 2824
https://t.co/KIcoS1mRFJ
Please also kindly have a glimpse at our Detailed Appendix, some presented here in comment section.
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🔬 Can 20 Fractions Compete? Early Results from HYPOCx-iRex Trial
A phase II RCT exploring hypofractionation in LACC. Promising? Let’s dive in
🎯 Objective
Evaluate safety & efficacy of 44 Gy/20F hypofractionated chemoradiation vs 45 Gy/25F
🏥 Methods
• Open-label RCT (n=40)
• IMRT + IGABT + weekly cisplatin
• HYPO arm: 44 Gy/20F over 39 days
• CVRT arm: 45 Gy/25F over 47 days
📊 Key Results
• 🔻 OTT: HYPO = 39d vs CVRT = 47d (P<0.001)
• GI tox Gr≥3: HYPO 43% vs CVRT 32% (NS)
• 18-mo para-aortic control: HYPO 100% vs CVRT 71% (P=0.003)
• HRQoL ↓ during HYPO but recovered by 3 mo
💡 Conclusion: HYPO is feasible, shortens OTT, and shows strong regional control. Long-term data awaited‼️
Hypofractionated Chemoradiation in Cervical Cancer with 44 Gy/20F VS 45 Gy/25F: A Phase II, Open-label RCT (HYPOCx-iRex trial)
Notably, PA control at 2y was significantly higher in HYPO (100% VS 71.2%, P=0.003). No significant differences were observed in local control or OS
Thank you @RatchaBest for preparing the last session of case discussion with Prof. @KenOlivierMD. Our residents really enjoy this 2-week teaching by Prof. Olivier as a visiting professor at @SirirajMedicine.
NSABP B-51/RTOG 1304 presented at #NRG2024
💥cN1 breast cancer pts who converted to ypN0 with neoadj chemo
💥no SS DFS or OS benefit to WBRT + RNI or CW RT inc RNI (superiority design)
💥thread below includes details from presentation
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@NRGonc
Feel like I've been living under a rock, but for anyone else who didn't know, @jryckman3 has made ALL his notes available at https://t.co/Bt80Vm9NuZ.
Name of site suggests RT-specific, but information spans onc specialties across almost all disease sites. Incredible.