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The “Undefined and Ignored Normal Tissue” Bulboclitoral Complex in Locally Advanced Cervical Cancer Treated with Definitive Radiochemotherapy: Is It Not the Organ at Risk?

Background and Objectives: The bulboclitoral complex (BCC) is an essential organ for female sexual health. However, it is not defined as an organ at risk in any guideline defining target volumes in radiotherapy of gynecological cancers, and there is no information about dose constraint. Materials and Methods: Simulation computed tomography scans of 20 patients diagnosed with locally advanced cervical cancer were used retrospectively. The volumetric modulated arc therapy treatment plan with a total dose of 45 Gy in 25 fractions was created using the planning target volume (PTV)-standard, which was created without considering the BCC, and the PTV-BCC spared, which were contoured and included in the optimization. Bulboclitoral complex doses in PTV-standard and PTV-BCC spared plans were compared using the paired simple t test. Results: Median BCC volume was 17.6 cm3 (11.20–25.50). Bulboclitoral complex maximum dose (Dmax) was median 49.07 Gy (48.49–50.25) and 28.81 Gy (18.14–44.61) in the PTV-standard and PTV-BCC spared plans, respectively, and the BCC Dmax was statistically significantly lower in the PTV-BCC spared plan (p < 0.001). When comparing BCC percentage of volume receiving 45 Gy (V45), the median values for PTV-standard and PTV-BCC spared plans were 37.5% (13.3–82.6) and 0%, respectively (p ≤ 0.001). Conclusions: The bulboclitoral complex can be dosimetrically protected from radiation by contouring and optimizing it as an organ at risk in the radiotherapy plan. The clinical effects of protecting the BCC from radiation as an organ at risk on sexual health need to be investigated.

Machine Learning-Based Prognostic Modelling Using MRI Radiomic Data in Cervical Cancer Treated with Definitive Chemoradiotherapy and Brachytherapy

Background: This study aims to evaluate the contribution of clinical and radiomic features to machine learning-based models for survival prediction in patients with locally advanced cervical cancer. Methods: Clinical and radiomic data from 161 patients were retrospectively collected from a single center. Radiomic features were obtained from contrast-enhanced magnetic resonance imaging (MRI) T1-weighted (T1W), T2-weighted (T2W), and diffusion-weighted (DWI) sequences. After data cleaning, feature engineering, and scaling, survival prediction models were created using the CatBoost algorithm with different data combinations (clinical, clinical + T1W, clinical + T2W, clinical + DWI). The performance of the models was evaluated using test accuracy, precision, recall, F1-score, ROC curve, and Bland–Altman analysis. Results: Models using both clinical and radiomic features showed significant improvements in accuracy and F1-score compared to models based solely on clinical data. In particular, the CatBoost_CLI + T2W_DMFS model achieved the best performance, with a test accuracy of 92.31% and an F1-score of 88.62 for distant metastasis-free survival prediction. ROC and Bland–Altman analyses further demonstrated that this model has high discriminative power and prediction consistency. Conclusions: The CatBoost algorithm shows high accuracy and reliability for survival prediction in locally advanced cervical cancer when clinical and radiomic features are combined. The addition of radiomics data significantly improves model performance.

Is Surgical Treatment an Option for Locally Advanced Cervical Cancer in the Presence of Central Residual Tumor after Chemoradiotherapy?

Abstract Objective To evaluate the outcomes of surgical treatment in patients with chemoradiotherapy (CRT)-resistant and locally advanced cervical cancer (LACC). Methods Patients with LACC who underwent surgery due to resistance to CRT between 2005 and 2015 were reviewed retrospectively. Disease-free survival (DFS) and overall survival (OS) related factors were analyzed. Results A total of 23 patients were included in the study and the median age was 51 years old. A total of 14 patients (60.8%) experienced recurrence; among these recurrences, 8 of them were local, 5 were distant, 1 was both distant and local. A total of 9 patients (39%) died. The Median DFS and OS durations were 15 and 32 months, respectively. A total of 17 patients (74%) had undergone simple hysterectomy, 4 (17%) radical hysterectomy, and 2 (9%) total pelvic exenteration. Postoperative grade 3 and 4 complications were seen in 12 patients (52%). Macroscopic tumor presence in the pathology specimen was associated with distant recurrence and positive surgical margins with local recurrence (Log-Rank test p = 0.029 and p = 0.048, respectively). The only factor associated with OS was surgical margin positivity (Log-Rank test p = 0.008). The type of surgery, grades 3 and 4 postoperative complications, brachytherapy, and tumor histology were not associated with recurrence. Conclusion In patients with LACC, hysterectomy is an option in the presence of a central residual tumor after CRT. However, the risk of grades 3 and 4 complications of performed surgery is high. The presence of macroscopic tumor in the pathology specimen and positive surgical margins are poor prognostic factors. The goal of the surgeon should be to achieve a negative surgical margin. It does not seem important if the surgery is simple or radical.