Introduction/Background To report the real-life results of preoperative brachytherapy of early-stage cervical cancer (ESCC) with risk factors for relapse

Methodology A retrospective analysis was made of the SFRO Brachytherapy Group cohort of patients with UCC for whom preoperative brachytherapy was proposed because of the presence of poor prognostic factors (tumor size > 2 cm, emboli, adenocarcinoma). Brachytherapy was followed 6 to 8 weeks later by surgery. Post-operative radio-chemotherapy was proposed in case of lymph node invasion. The primary objective is to analyze the local relapse rate, the secondary objectives are the study of metastasis-free survival, disease-free survival, overall survival, and early and late toxicities. Univariate and multivariate analyses were performed for oncologic prognostic factors.

Results Between 2001 and 2019, 328 patients with ESCC treated with preoperative brachytherapy were identified. Tumor stages were as follows: 313 stages IB1 (95.4%), 6 stages IB2 (1.8%) and 9 stages IIA (2.8%). The median tumor size was 25 mm (20–40 mm) with the presence of emboli in 46 patients (14%) and 160 patients (48.8%) had an adenocarcinoma type tumor. A total of 239 patients (72.9%) showed a complete histological response after analysis of the hysterectomy specimen and 30 patients required further treatment with radiotherapy+/chemotherapy. After a median follow-up of 72 months (4–168), 51 recurrences (15.5%) were noted, including 11 (3.3%) at the local level. The 5-year local recurrence-free survival, metastatic recurrence-free survival and overall survival were 94% [88–100], 89% [83–99] and 91% [85–100], respectively. Four patients (1.21%) experienced acute and 1 (0.30%) late grade ≥3 urinary toxicity. There were no grade ≥2 acute or late vaginal toxicities.

Conclusion To date, this is the largest French cohort of preoperative brachytherapy. This treatment regimen could be an interesting option for ESCC with risk factors for local recurrence.