title: Pathologic complete remission after preoperative high-dose-rate brachytherapy in patients with operable cervical cancer: preliminary results of a prospective randomized multicenter study.
abstract: The role of preoperative intrauterine brachytherapy (BT) in the multidisciplinary treatment of early stage cervical carcinoma (ESCC) is controversial. In 2005, a prospective randomized multicenter study was initiated in Hungary in order to explore the potential advantages of preoperative high-dose-rate (HDR) BT. In this article we evaluate the efficiency of preoperative HDR BT by the rate of pathologic complete remission (pCR) in the first 185 patients enrolled in the study at the National Institute of Oncology and at the Uzsoki Municipal Cancer Center in collaboration with the 1st Department of Gynaecology and Obstetrics of Semmelweis University, Budapest, Hungary. In arm A, patients received 2x8Gy preoperative intracavitary HDR BT, while in arm B no preoperative treatment was given. In both arms patients underwent radical Wertheim (Piver III) hysterectomy. The pCR rate was 25.7% after preoperative HDR BT, while it was only 11.2% with surgery alone (p=0.03), in these cases the tumor was eliminated during the diagnostic excision or conisation. The rate of positive surgical margins was 1.5% after preoperative BT, while it was as high as 11.4% without preoperative RT (p=0.02). There was no significant difference in the local tumor control (LTC), distant metastases free survival (DMFS) and overall survival (OS) between the two arms. According to our preliminary results preoperative intracavitary HDR BT significantly increases the rate of pCR and decreases the rate of positive surgical margins in patients with ESCC. Longer follow-up is required to establish the possible impact of pCR on the ultimate LTC and OS.
authors.affiliation: National Institute of Oncology, Center of Radiotherapy, Budapest, Hungary, juliavizkeleti@yahoo.com.
authors.forename: Julia
authors.initials: J
authors.lastname: Vízkeleti
authors.forename: Ildikó
authors.initials: I
authors.lastname: Vereczkey
authors.forename: Georgina
authors.initials: G
authors.lastname: Fröhlich
authors.forename: Szilvia
authors.initials: S
authors.lastname: Varga
authors.forename: Katalin
authors.initials: K
authors.lastname: Horváth
authors.forename: Tamás
authors.initials: T
authors.lastname: Pulay
authors.forename: Imre
authors.initials: I
authors.lastname: Pete
authors.forename: Csaba
authors.initials: C
authors.lastname: Nemeskéri
authors.forename: Árpád
authors.initials: Á
authors.lastname: Mayer
authors.forename: Norbert
authors.initials: N
authors.lastname: Sipos
authors.forename: Miklós
authors.initials: M
authors.lastname: Kásler
authors.forename: Csaba
authors.initials: C
authors.lastname: Polgár
mesh_terms: D001918:Brachytherapy / Q000379:methods*; D004307:Dose-Response Relationship, Radiation; D005260:Female; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures; D006801:Humans; D006814:Hungary; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods*; D011446:Prospective Studies; D012074:Remission Induction / Q000379:methods; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery*