Naoya MurakamiKen AndoMasumi MurataKazutoshi MurataTatsuya OhnoTomomi AoshikaShingo KatoNoriyuki OkonogiAnneyuko I. SaitoJoo Young KimYasuko KumaiYasuo YoshiokaShuhei SekiiKayoko TsujinoChairat LowanichkiattikulPoompis PattaranutapornYuko KaneyasuTomio NakagawaMiho WatanabeTakashi UnoRei UmezawaKeiichi JinguAyae KanemotoMasaru WakatsukiKatsuyuki ShiraiHiroshi IgakiJun ItamiHyogo Cancer CenterNational Hospital Organization Fukuyama Medical CenterGraduate School of MedicineSaitama Medical University International Medical CenterGraduate School of MedicineQST HospitalGunma Prefectural Cancer CenterJichi Medical UniversityNational Cancer Center, GyeonggiCancer Institute Hospital of Japan Foundation for Cancer ResearchNational Cancer Center HospitalFaculty of Medicine Ramathibodi Hospital, Mahidol UniversityNiigata Cancer Center HospitalJuntendo University School of MedicineChiba University HospitalKita-Harima Medical Center2022-08-042022-08-042021-10-01Gynecologic Oncology. Vol.163, No.1 (2021), 105-10910956859009082582-s2.0-85110761151https://repository.li.mahidol.ac.th/handle/20.500.14594/77829Objective: The majority of uterine cervical cancer is known to be related to human papillomavirus (HPV), and HPV-related tumors are known to be radio-sensitive. In the management of HPV-related oropharyngeal cancer, de-intensification of treatment has been attempted; however, no such attempt is performed in the management of cervical cancer. The aim of this study was to identify a group of patients who can safely be treated by de-escalated treatment intensity. Methods: From the Asian international multi-institutional retrospective study involving 13 Japanese, one Thailand, and one Korean institutions based on 469 patients, squamous cell carcinoma (Scc), tumor reduction ratio ≥29%, tumor size before brachytherapy ≤4 cm, and total treatment time (TTT) <9 weeks were identified as factors having an influence on local control. Based on these findings, low-risk patients having these four factors were extracted, and treatment outcomes categorized in 10 Gy increment of CTVHR D90 were compared. Results: Among 469 patients, 162 patients (34.5%) met the criteria of low-risk group, and 63, 41, 43, and 15 patients were categorized in CTVHR D90 50–60 Gy, 60–70 Gy, 70–80 Gy, and >80 Gy, respectively. While 4-y progression-free survival ranged from 66 to 80%, 4-y local control was consistently over 90% in every dose group. Rectum and bladder D2cc and incidence of late adverse events decreased as CTVHR D90 decreased. Conclusions: The low-risk patients achieved favorable local control with CTVHR D90 <80 Gy. A personalized treatment strategy based on tumor response could also be adopted for cervical cancer.Mahidol UniversityMedicineArticleSCOPUS10.1016/j.ygyno.2021.07.021