title: Brachytherapy versus radical hysterectomy after external beam chemoradiation: a non-randomized matched comparison in IB2-IIB cervical cancer patients.
abstract: BACKGROUND
  A current paradigm in the treatment of cervical cancer with radiation therapy is that intracavitary brachytherapy is an essential component of radical treatment. This is a matched retrospective comparison of the results of treatment in patients treated with external beam chemoradiation (EBRT-CT) and radical hysterectomy versus those treated with identical chemoradiation followed by brachytherapy.
  
  
  METHODS
  In this non-randomized comparison EBRT-CT protocol was the same in both groups of 40 patients. In the standard treated patients, EBRT-CT was followed by one or two intracavitary Cesium (low-dose rate) applications within 2 weeks of finishing external radiation to reach a point A dose of at least 85 Gy. In the surgically treated patients, radical hysterectomy with bilateral pelvic lymph node dissection and para-aortic lymph node sampling were performed within 7 weeks after EBRT-CT. Response, toxicity and survival were evaluated.
  
  
  RESULTS
  A total of 80 patients were analyzed. The patients receiving EBRT-CT and surgery were matched with the standard treated cases. There were no differences in the clinicopathological characteristics between groups or in the delivery of EBRT-CT. The pattern of acute and late toxicity differed. Standard treated patients had more chronic proctitis while the surgically treated had acute complications of surgery and hydronephrosis. At a maximum follow-up of 60 months, median follow-up 26 (2-31) and 22 (3-27) months for the surgery and standard therapy respectively, eight patients per group have recurred and died. The progression free and overall survival are the same in both groups.
  
  
  CONCLUSIONS
  The results of this study suggest that radical hysterectomy can be used after EBRT-CT without compromising survival in FIGO stage IB2-IIB cervical cancer patients in settings were brachytherapy is not available. A randomized study is needed to uncover the value of surgery after EBRT-CT.
authors.affiliation: Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México/INCan, Mexico City, México. micuentalucely@yahoo.com
authors.forename: Lucely
authors.initials: L
authors.lastname: Cetina
authors.forename: Alicia
authors.initials: A
authors.lastname: Garcia-Arias
authors.forename: Myrna
authors.initials: M
authors.lastname: Candelaria
authors.forename: David
authors.initials: D
authors.lastname: Cantú
authors.forename: Lesbia
authors.initials: L
authors.lastname: Rivera
authors.forename: Jaime
authors.initials: J
authors.lastname: Coronel
authors.forename: Blanca
authors.initials: B
authors.lastname: Bazan-Perkins
authors.forename: Vladimir
authors.initials: V
authors.lastname: Flores
authors.forename: Aaron
authors.initials: A
authors.lastname: Gonzalez
authors.forename: Alfonso
authors.initials: A
authors.lastname: Dueñas-González
mesh_terms: D000230:Adenocarcinoma / Q000556:secondary / Q000628:therapy; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001918:Brachytherapy; D018196:Carcinoma, Adenosquamous / Q000556:secondary / Q000628:therapy; D002294:Carcinoma, Squamous Cell / Q000556:secondary / Q000628:therapy; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008198:Lymph Nodes / Q000473:pathology; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000628:therapy*; D000093542:Gemcitabine
chemical_list: D003841:Deoxycytidine; D002945:Cisplatin; D000093542:Gemcitabine