{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,7]],"date-time":"2026-11-07T14:35:59Z","timestamp":1794062159420,"version":"4.8.0"},"reference-count":39,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2023,3,27]],"date-time":"2023-03-27T00:00:00Z","timestamp":1679875200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/501100001691","name":"KAKENHI","doi-asserted-by":"publisher","award":["JP19K08179"],"award-info":[{"award-number":["JP19K08179"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To assess the feasibility of external beam radiotherapy without central shielding in definitive radiotherapy for Japanese patients with cervical cancer.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We retrospectively analysed the data of cervical cancer patients treated with definitive radiotherapy consisting of external beam radiotherapy without central shielding and three-dimensional-image-guided brachytherapy.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The study included 167 patients (T1\u00a0+\u00a02\u00a0=\u00a0108, T3\u00a0+\u00a04\u00a0=\u00a059) from eight Japanese institutions. For three-dimensional-image-guided brachytherapy, intra-cavitary and interstitial brachytherapy was utilized in 33 patients (20%). The median follow-up was 26.6\u00a0months (interquartile range, 20\u201343.2). The maximum rectal D2 (75\u00a0Gy)\/bladder D2 (90\u00a0Gy) constraints were deviated by 6%\/10% and 10%\/5% for T1\u00a0+\u00a02 and T3\u00a0+\u00a04, respectively. The 2-year incidence of \u2265grade 3 proctitis\/cystitis was 4%\/1% for T1\u00a0+\u00a02 and 10%\/2% for T3\u00a0+\u00a04. The 2-year local progression-free survival was 89% for T1\u00a0+\u00a02 and 82% for T3\u00a0+\u00a04. For T1\u00a0+\u00a02, the 2-year local progression-free survival for the high-risk clinical target volume D90\u00a0\u2265\u00a068\u00a0Gy (indicated by receiver operating characteristic analysis; area under the curve\u00a0=\u00a00.711) was 92% versus 67% for &amp;lt;68\u00a0Gy (log-rank; P\u00a0=\u00a00.019). Cox multivariate analysis indicated that the high-risk clinical target volume D90 was one of independent predictors of local failure (P\u00a0=\u00a00.0006). For T3\u00a0+\u00a04, the 2-year local progression-free survival was 87% for the high-risk clinical target volume &amp;lt;82\u00a0cm3 (area under the curve\u00a0=\u00a00.67) and 43% for \u226582\u00a0cm3 (P\u00a0=\u00a00.0004). Only the high-risk clinical target volume was an independent predictor of local failure (P\u00a0=\u00a00.0024).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Definitive radiotherapy consisting of external beam radiotherapy without central shielding and three-dimensional-image-guided brachytherapy was feasible for Japanese patients with cervical cancer. Dose de-escalation from the current global standards is suggested for patients with T1\u00a0+\u00a02 disease.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jjco\/hyad022","type":"journal-article","created":{"date-parts":[[2023,3,28]],"date-time":"2023-03-28T16:23:34Z","timestamp":1680020614000},"page":"480-488","source":"Crossref","is-referenced-by-count":6,"title":["Definitive radiotherapy consisting of external beam radiotherapy without central shielding and 3D image-guided brachytherapy for patients with cervical cancer: feasibility for Japanese patients and dose\u2013response analyses for local control in the low-dose range"],"prefix":"10.1093","volume":"53","author":[{"given":"Takafumi","family":"Toita","sequence":"first","affiliation":[{"name":"Okinawa Chubu Hospital Radiation Therapy Center, , Okinawa, Japan"},{"name":"University of the Ryukyus Department of Radiology, Graduate School of Medical Science, , Okinawa, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kentaro","family":"Wada","sequence":"additional","affiliation":[{"name":"Osaka International Cancer Institute Hospital Department of Radiation Oncology, , Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinya","family":"Sutani","sequence":"additional","affiliation":[{"name":"National Hospital Organization Tokyo Medical Center Department of Radiation Oncology, , Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rei","family":"Umezawa","sequence":"additional","affiliation":[{"name":"Tohoku University Graduate School of Medicine Department of Radiation Oncology, , Sendai, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hitoshi","family":"Maemoto","sequence":"additional","affiliation":[{"name":"University of the Ryukyus Department of Radiology, Graduate School of Medical Science, , Okinawa, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noriko","family":"Ii","sequence":"additional","affiliation":[{"name":"Ise Red Cross Hospital Department of Radiation Oncology, , Mie, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomoko","family":"Kawamura","sequence":"additional","affiliation":[{"name":"Mie University Hospital Department of Radiology, , Mie, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hitoshi","family":"Ikushima","sequence":"additional","affiliation":[{"name":"Tokushima University Graduate School Department of Therapeutic Radiology, , Tokushima, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryosuke","family":"Takenaka","sequence":"additional","affiliation":[{"name":"University of Tokyo Hospital Department of Radiology, , Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koji","family":"Konishi","sequence":"additional","affiliation":[{"name":"Osaka International Cancer Institute Hospital Department of Radiation Oncology, , Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atsunori","family":"Yorozu","sequence":"additional","affiliation":[{"name":"National Hospital Organization Tokyo Medical Center Department of Radiation Oncology, , Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keiichi","family":"Jingu","sequence":"additional","affiliation":[{"name":"Tohoku University Graduate School of Medicine Department of Radiation Oncology, , Sendai, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takuro","family":"Ariga","sequence":"additional","affiliation":[{"name":"University of the Ryukyus Department of Radiology, Graduate School of Medical Science, , Okinawa, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshihito","family":"Nomoto","sequence":"additional","affiliation":[{"name":"Mie University Hospital Department of Radiology, , Mie, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideomi","family":"Yamashita","sequence":"additional","affiliation":[{"name":"University of Tokyo Hospital Department of Radiology, , Tokyo, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,3,27]]},"reference":[{"key":"2023060113502840500_ref1","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1016\/j.radonc.2018.03.003","article-title":"The European Society of Gynaecological Oncology\/European Society for Radiotherapy and Oncology\/European Society of Pathology guidelines for the management of patients with cervical cancer","volume":"127","author":"Cibula","year":"2018","journal-title":"Radiother 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National survey of intracavitary brachytherapy for intact uterine cervical cancer in Japan","volume":"59","author":"Toita","year":"2018","journal-title":"J Radiat Res"},{"key":"2023060113502840500_ref5","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1016\/j.ijrobp.2014.10.053","article-title":"MRI-guided high-dose-rate intracavitary brachytherapy for treatment of cervical cancer: the University of Pittsburgh experience","volume":"91","author":"Gill","year":"2015","journal-title":"Int J Radiat Oncol Biol Phys"},{"key":"2023060113502840500_ref6","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1016\/j.ijrobp.2015.04.043","article-title":"Clinical outcomes of computed tomography-based volumetric brachytherapy planning for cervical cancer","volume":"93","author":"Simpson","year":"2015","journal-title":"Int J Radiat Oncol Biol 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