Introduction/Background To analyze the clinical outcomes and the safety of preoperative high-dose-rate (HDR) image-guided adaptive brachytherapy (IGABT) followed by minimally invasive surgery (MIS) in the multidisciplinarymanagement of early-stage cervical cancer.

Methodology Medical records of all consecutive patients with early-stage cervical cancer treated at our institution between 2012 and 2018 with preoperative IGABT in a multidisciplinary approach were reviewed. Treatment schedule was pelvic node dissection,preoperative IGABT followed 6–8 week later by MIS hysterectomy.

Results Seventy patients with cervical cancer FIGO stages (IB1 18.6%, IB2 75.7% and IIA1 5.7%) were treated by preoperative HDR brachytherapy. With a median follow-up of 37.4 months [95% confidence interval, 32.1–39.7 months] isolated vaginal vault recurrencewas not observed, 3 pelvic relapses were reported (4.3%). None of patients received postoperative radiotherapy (EBRT) or radiochemotherapy. The estimated 3-year local and pelvis relapse free survival for the entire populationwere respectively 98% [95% confidence interval, 89%-100%] and 90% [80%-96%]. The estimated 3-year disease-free survival (DFS) for the entire population was 88% [77–94%]. The 3-year overall survival (OS) ratewas 97% [88%-99%]. Microscopic vaginal resection margin (R1) was observed in one patient ([1].4%). Lymph-vascular space invasion (LVSI)was found found in 6 (8.6%) patients. Forty-eight late complications in 36 patients (51.4%)were observed. Five (7.1%) grade 3 vaginal wound dehiscence toxicities were observed. Urinary and gastrointestinal toxicities were grade 1–2. No grade 4–5 complications were observed.

Conclusion Preoperative image-guided adaptive brachytherapy followed byminimally invasive surgery allows high local control, reduces positive surgicalmargins and rates of lymph-vascular space invasion avoiding adjuvants treatments. Surgical approaches must be discussedwith patients including preoperative brachytherapy as a downstaging treatment.