[Treatment of cancers limited to the uterine cervix with simple hysterectomy using a vaginal approach after brachytherapy].
OBJECTIVE
In patients with early cervix carcinoma, both radiotherapy and surgery or combined modalities provide effective therapies. In the two last modalities, recommended surgery is radical hysterectomy. The purpose of this prospective study was to assess the value of a limited vaginal hysterectomy after brachytherapy in patients without any unfavorable prognostic factor.


METHODS
Twenty-two patients (stage Ia2 with vascular invasion: three patients, stage Ib 1:19 patients) with 1 cm median maximal tumor size and with previous negative laparoscopic lymphadenectomy (median number of lymph nodes: 12) underwent a limited vaginal hysterectomy 6 weeks after utero-vaginal brachytherapy.


RESULTS
Two mild intra-operative complications were noted. Venous hemorrhage (100 mL) occurred in one patient during lymphadenectomy and another patient presented bladder injury during hysterectomy. These two complications were successfully controlled with no need for laparotomy. Only one late complication was observed: bladder grade G2 (b). With a 29 months follow-up (20-48 months), no recurrence was reported.


CONCLUSIONS
These results appear promising in patients with very early cervix carcinoma but remain to be confirmed on a larger scale.
Resbeut
M
M
Département de radiothérapie, Institut Paoli-Calmettes, Marseille, France.
Cravello
L
L
Hannoun-Lévi
J M
JM
Agostini
A
A
Alzieu
C
C
Cowen
D
D
D000328:Adult; D001918:Brachytherapy; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007045:Hysterectomy, Vaginal; D008197:Lymph Node Excision; D008875:Middle Aged; D009367:Neoplasm Staging; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*