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 (.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.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.