title: Outcome in early cervical cancer following pre-operative low dose rate brachytherapy: a ten-year follow up of 257 patients treated at a single institution.
abstract: OBJECTIVE
  To report the outcome of preoperative low dose rate uterovaginal brachytherapy (LDR-UVBT) followed by radical surgery in the treatment of early cervical carcinoma.
  
  
  METHODS
  257 patients treated at Institut Curie from 1985 to 2008 for cervical carcinoma less than 4cm (FIGO stages Ib1, IIA and IIB) were studied. Patients received preoperative LDR-UVBT followed by hysterectomy Piver II type, with pelvic lymph nodes dissection (PLND). Predictive factors for pathological response to brachytherapy were analyzed with logistic regression, as well as survival rates.
  
  
  RESULTS
  44% of patients had residual tumor, 4.3% of patients had parametrial invasion and 17.9% of patients had lymph node involvement. Predictive factors for an incomplete pathological response were: initial clinical tumor size 20mm (OR 2.1), pN1 (OR 2.77), glandular carcinoma (OR 2.51) and lymphovascular invasion (OR 4.35). 7.4% and 2.7% of patients had respectively grade 2 and grade 3 post-therapeutic late complications. Median follow up was 122 months [1-282]. Five-year actuarial overall survival and disease free survival were respectively 83% CI [78.3-87.5] and 80.9% CI [76.3-85.7]. In multivariate analysis, factors affecting significantly the overall survival and disease free survival rates were: lymph node involvement (RR 4.53 and 8.96 respectively), parametrial involvement (RR 5.69 and 5.62 respectively), smoking (RR 3.07 and 2.63 respectively).
  
  
  CONCLUSIONS
  Preoperative LDR-UVBT results in good disease control with a low complications rate. Its accuracy could be improved by a better selection of patients. Lymph nodes and parametrial evaluation remains a challenging issue that should be achieved with imaging and minimal invasive surgery.
authors: Department of Surgical Oncology, Institut Curie, 75005 Paris, France. charlotte.ngo@curie.net
authors: C
authors: C
authors: Ngô
authors: S
authors: S
authors: Alran
authors: C
authors: C
authors: Plancher
authors: V
authors: V
authors: Fourchotte
authors: P
authors: P
authors: Petrow
authors: M
authors: M
authors: Campitelli
authors: S
authors: S
authors: Batwa
authors: X
authors: X
authors: Sastre
authors: R J
authors: RJ
authors: Salmon
authors: A
authors: A
authors: de la Rochefordière
mesh_terms: D000328:Adult; D000368:Aged; D001918:Brachytherapy; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D011446:Prospective Studies; D012907:Smoking / Q000009:adverse effects; D015996:Survival Rate; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery