Objectives The aim of this study is to report the oncological and surgical outcomes of an alternative treatment strategy to upfront surgery for patients presenting with early stage cervical cancer (ESCC) (FIGO 2018 stages IA1-IB2). This treatment strategy consists of a combination preoperative brachytherapy (POBT) followed by a Querleu Morrow Type A laparoscopic or abdominal hysterectomy.

Material and Methods This retrospective study was conducted at the Marseille regional tertiary cancer center in France for patients treated for ESCC (FIGO 2018 stages IA1-IB2) between 2001 to 2012. All patients underwent a Low Dose Rate (LDR) POBT after confirming the absence of pelvic lymph node metastasis (radiological and surgical staging). 6 to 8 weeks after brachytherapy completion, all patients underwent a Querleu Morrow Type A hysterectomy (laparotomy and minimally invasive). The primary endpoint was the Disease Free Survival (DFS) and the secondary endpoint was the morbidity related to this radio-surgical multimodal approach.

Results A total of 138 patients were included. Histological analysis showed a complete response in 68 patients (49.3%) and a residual tumor < 1 cm in 36 patients (26%).

With a median follow up of 132 months (60 – 204 months), DFS was 93.5% and 9 recurrences occurred (1 local pelvic recurrence, 2 pelvic lymph node recurrences and 6 distant recurrences).

In univariate analysis, we found that a duration between the completion of brachytherapy and surgery exceeding 52 days is associated with a significant decrease in DFS (p = 0.004, OR = 8.5, 95% CI {1.5; 48.7}). Pathological complete response was found to be associated with an increased DFS (p = 0.03 OR = 6.1 95% CI {1.8; 55.3}).

The brachytherapy related rate of late complications was 17.3% (n=24) (Chassagne glossary) and the surgery related urinary tract complications rate was 6.5% (n=9), with only 2 patients (1.5%) presented grade 3 complications (Clavien Dindo classification).

Conclusion After a median follow up of 132 months, the multimodal radio-surgical management of ESCC (FIGO 2018 Stages IA1-IB2) consisting of POBT followed by a Querleu Morrow Type A laparoscopic hysterectomy appears to be a reasonable alternative to upfront open radical hysterectomy particularly in patients with high risk ESCC (<2 cm associated with negative prognostic factors or for tumors measuring between 2 and 4 cm).

This multimodal radio-surgical approach is associated with a low rate of complications and a reasonable rate of local recurrences compared to the results of the LACC trial. Further studies are necessary to confirm these results.

Disclosures Doctors Clémence Beyer, Houssein El Hajj, Laurence Gonzague, Leonel Varela Cagetti, Camille Jauffret-Fara, Guillaume Blache, Laura Sabiani, Magalie Provansal and Renaud Sabatier have no conflicts of interest or financial ties to disclose.

Gilles Houvenaeghel and Eric Lambaudie are proctors for Intuitive Surgical.