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Clinical Application of Proton Therapy and Advanced Radiotherapy in Gynecological Cancer

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Special Issue Editors

Dr. Amy Tien Yee Chang

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Guest Editor

Hong Kong Sanatorium & Hospital, Happy Valley, Hong Kong
Interests: proton therapy; gynecological cancer; MR-guided radiotherapy; brachytherapy

Dr. Bin Yang

E-Mail Website
Guest Editor

Medical Physics Department, Hong Kong Sanatorium & Hospital, Happy Valley, Hong Kong
Interests: proton therapy; motion management; MRgRT; adaptive radiotherapy; AI applications in radiotherapy

Special Issue Information

Dear Colleagues,

Radiotherapy is pivotal in the definitive treatment of gynecological cancers: as curative intent in locally advanced cervical cancer with brachytherapy and vaginal cancers; as post-operative therapy in endometrial, cervical and vulval cancers, and for isolated recurrences such as para-aortic or other regional nodal or bone recurrence. Intensity-modulated radiotherapy emerges as the new gold standard compared to the conventional four-field “box” technique, with merits in reducing acute and late gastrointestinal and urinary toxicities. A more sophisticated technique using image-guidance, such as tomotherapy using MVCT or MR-guided radiotherapy with the latest MR-Linac technology, allows margin reduction and potential further sparing of toxicities. Proton or heavy-particle therapy is now being investigated as a superior modality, with studies demonstrating dosimetric improvement, especially in a post-operative setting and extended field para-aortic irradiation.

This Special Issue aims to illustrate current clinical experience in the latest image-guided radiotherapy or proton therapy applications across gynecological cancer applications.

Dr. Amy Tien Yee Chang
Dr. Bin Yang
Guest Editors

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Research

11 pages, 404 KB

Open AccessArticle

Preliminary Results Regarding the Feasibility and Outcomes of MR-Linac Adaptive Stereotactic Body Radiotherapy Combined with Systemic Treatment Among Patients with Pelvic–Abdominal Recurrent or Metastatic Gynecological Malignancies: A Single-Institution Experience

by Xi Yang, Shuang Zhao, Zexuan Liu, Lu Zhang, Duan Yang, Shuangzheng Jia, Jusheng An and Manni Huang

Cancers 2026, 18(7), 1112; https://doi.org/10.3390/cancers18071112 - 30 Mar 2026

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Abstract

Objective: Inadequate radiation delivery to recurrent pelvic and abdominal tumors is frequently attributable to the dose limitations of surrounding normal structures, particularly the intestines. Radiotherapy guided by magnetic resonance imaging (MRI) significantly enhances the accuracy of soft-tissue delineation. The purposes of this study were to demonstrate the feasibility and effectiveness of MR-Linac Adaptive stereotactic body radiotherapy in patients with pelvic–abdominal recurrent or metastatic gynecological malignancies with or without systemic therapies. Methods: Patients with pelvic–abdominal recurrent or metastatic gynecological malignancies are eligible for MR-Linac Adaptive stereotactic body radiotherapy. Systemic therapies, including chemotherapy, immunotherapy, and targeted therapy, are considered acceptable treatment options. The safety, tolerability, and efficacy of MR-Linac Adaptive stereotactic body radiotherapy were assessed. Results: Between October 2019 and May 2025, 15 patients were subjected to MR-Linac Adaptive stereotactic body radiotherapy. With a median follow-up period of 4.67 months (range, 0.73–20.10 months), the 6-month overall survival (OS), progression-free survival (PFS), and local control (LC) rates were 93.3%, 66.0%, and 92.3%, respectively. The 12-month OS, PFS, and LC rates were 83.8%, 37.7%, and 70.5%, respectively. The best objective response rate (ORR = CR + PR) for the irradiated lesions was 73.3% (11/15 patients). MR-Linac Adaptive stereotactic body radiotherapy led to objective responses in 73.3% (11/15) of the patients. As of the data cutoff (28 May 2025), one patient experienced dose-limiting toxicity (an enteric fistula). Another patient developed grade 4 thrombocytopenia during treatment; it was considered chemotherapy-induced. Conclusions: These findings suggest that MR-Linac Adaptive stereotactic body radiotherapy is relatively effective and safe and can be an important treatment option for patients with pelvic–abdominal recurrent or metastatic gynecological malignancies. MR-Linac Adaptive stereotactic body radiotherapy exhibited acceptable tolerability, promising efficacy, and a favorable local control rate with regard to heavily pretreated advanced solid tumors. Full article

(This article belongs to the Special Issue Clinical Application of Proton Therapy and Advanced Radiotherapy in Gynecological Cancer)

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16 pages, 1210 KB

Open AccessArticle

Comprehensive Comparison of Surgery Followed by Radiotherapy and Radical Radiotherapy for Cervical Cancer: A Multicenter Retrospective Propensity-Score-Matched Analysis

by Junyi Liu, Youwen Zhu, Kun Liu, Dongfeng Deng, Qiuping Yang, Weisong Wang, Xianyu Liu and Hong Zhu

Cancers 2026, 18(5), 865; https://doi.org/10.3390/cancers18050865 - 7 Mar 2026

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Abstract

Background: While surgery and radiotherapy are the standard of care for patients with cervical cancer (CC), debate persists regarding the choice of whether treatment should consist of surgery followed by radiotherapy or initial direct radical radiotherapy. The present study was therefore devised to compare real-world clinical outcomes and economic assessments associated with these different treatment approaches. Methods: Six tertiary medical centers retrospectively identified patients with International Federation of Gynecology and Obstetrics (FIGO) 2018 stage I-IVA CC who underwent surgery followed by radiotherapy (surgery–radiotherapy group) or radical radiotherapy (radiotherapy group) between 2015 and 2023 in China. The progression-free and overall survival (PFS and OS) of these patients were compared using Kaplan–Meier and propensity-score-weighted proportional risk models. Economic analyses were also conducted based on patient follow-up for up to 8 years from the start of treatment. Results: A total of 980 patients receiving surgery–radiotherapy and radiotherapy were identified for matching. Propensity score weighting revealed no significant statistical differences in PFS (hazard ratio [HR], 0.75; 95% confidence interval [CI], 0.44–1.28; p = 0.29) and OS (HR, 0.49; 95% CI, 0.20–1.21; p = 0.12) when comparing these groups. Subgroup analysis found differences in PFS (HR, 0.17; 95% CI, 0.04–0.77; p = 0.02) among adenocarcinoma. Economic analyses revealed that the incremental cost-effectiveness ratio of the surgery–radiotherapy group versus the radiotherapy group was $40,831/quality-adjusted life-year (QALY), which is higher than the Chinese willingness-to-pay threshold of $35,841/QALY. Conclusions: Survival outcomes were similar for patients with CC who underwent surgery–radiotherapy and radiotherapy. Further, radical radiotherapy may be cost-effective for such patients considering economic factors in China. Full article

(This article belongs to the Special Issue Clinical Application of Proton Therapy and Advanced Radiotherapy in Gynecological Cancer)

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