AccScience Publishing / EJMO / Online First / DOI: 10.36922/EJMO026080091
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ORIGINAL RESEARCH ARTICLE

Analysis of risk factors after three-dimensional brachytherapy for cervical cancer: A real-world study

Haonan Han1,2† ,  Dongmin Liu3† ,  Chengwu Zhang4 ,  Yuan Dong1,2 ,  Pan Qi1,2 ,  Siyang Zhang1,2 ,  Liming Xu3,5* ,  Xiaofeng Yao1,2*
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1 Department of Plastic Surgery, Xiangyang Hospital of Traditional Chinese Medicine, Xiangyang Hospital affiliated to Hubei University of Chinese Medicine, Xiangyang, Hubei, China
2 Hubei Provincial Clinical Research Center for Integrative Medicine in Cancer Green Therapy, Xiangyang, Hubei, China
3 Department of Radiation Oncology, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, Tianjin’s Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
4 Plastic Surgery Department, Third Xiangya Hospital of Central South University, Changsha, Hunan, China
5 Department of Radiation Oncology, Tianjin Cancer Hospital Airport Hospital, Tianjin, China
†These authors contributed equally to this work.
EJMO, 026080091 https://doi.org/10.36922/EJMO026080091
Received: 20 February 2026 | Revised: 29 April 2026 | Accepted: 3 June 2026 | Published online: 22 June 2026
© 2026 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC-by the license) ( https://creativecommons.org/licenses/by-nc/4.0/ )
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Abstract

Introduction: Cervical cancer is a common malignancy of the female reproductive system. This study retrospectively analyzed cervical cancer patients treated with three-dimensional brachytherapy (3D-BT) to evaluate the effects of radiotherapy dose, treatment fractions, and combined therapeutic modalities on prognosis.

Objectives: To identify prognostic factors associated with treatment efficacy and provide evidence for individualized treatment strategies.

Methods: In this retrospective cohort study, data from cervical cancer patients treated with 3D-BT at Tianjin Cancer Hospital and Xiangyang Hospital of Traditional Chinese Medicine were collected. Variables included radiotherapy dose, treatment fractions, and combined treatment modalities. Kaplan–Meier and Cox regression analyses were performed using R and SPSS to identify prognostic factors associated with survival outcomes.

Results: Concurrent chemoradiotherapy, targeted therapy plus chemotherapy, targeted therapy plus hyperthermia, immunotherapy plus chemotherapy, immunotherapy plus hyperthermia, and hyperthermia plus chemotherapy were associated with improved progression-free survival (PFS) (all p < 0.001). Concurrent chemoradiotherapy (hazard ratio [HR]: 0.436, 95% confidence interval [CI]: 0.227–0.839, p = 0.013) and hyperthermia plus chemotherapy (HR: 0.106, 95% CI: 0.013–0.837, p = 0.033) were associated with reduced overall survival (OS) risk. A total brachytherapy dose > 2,800 cGy (HR: 0.177, 95% CI: 0.041–0.771, p = 0.021) and hyperthermia plus chemotherapy (HR: 0.186, 95% CI: 0.055–0.630, p = 0.007) were independently associated with improved PFS. More than four brachytherapy fractions were also associated with better PFS.

Conclusion: Higher brachytherapy doses (>2,800 cGy) and certain combination strategies, particularly concurrent chemoradiotherapy with hyperthermia, were associated with improved PFS and OS. However, the absence of key prognostic variables limits interpretation, and prospective studies are required to confirm these findings.

Keywords
Cervical cancer
Three-dimensional brachytherapy
Radiotherapy
Prognostic correlates
Treatment modalities
Funding
This study is funded by Demonstration Project 2025 for Reform and High-Quality Development of National Public Hospitals (Informal Letter for Public Hospital Reform and Department of Institutional Reform, National Health Commission of the People’s Republic of China [2025] No. 3).
Conflict of interest
The authors declare they have no competing interests.
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Eurasian Journal of Medicine and Oncology, Electronic ISSN: 2587-196X Print ISSN: 2587-2400, Published by AccScience Publishing
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