title: Early stage cervical cancer: Brachytherapy followed by type a hysterectomy versus type B radical hysterectomy alone, a retrospective evaluation.
abstract: BACKGROUND
  Two options are possible for the management of early stage cervical cancer, without lymph node involvement: radical surgery or brachytherapy followed by surgery. The aim of this study was to compare overall survival (OS) and disease-free survival (DFS) of early stage cervical cancers managed by uterovaginale brachytherapy followed by extrafasciale hysterectomy (group 1) or by radical hysterectomy alone (group 2). The secondary objectives were to compare the morbidity of these two different approaches and to evaluate the parametrial involvement rate in patients managed by radical hysterectomy.
  
  
  METHODS
  It is a retrospective and collaborative study between the Paoli Calmettes Institute (Marseille) and the Oscar Lambret Center (Lille) from 2001 to 2013, in patients with tumors FIGO stages IA1, IA2, IB1 and IIA less than 2 cm of diameter, without pelvic lymph node involvement.
  
  
  RESULTS
  One hundred and fifty-one patients were included (74 in group 1 and 77 in group 2). The demographic characteristics of the two groups were comparable. OS and DFS were respectively 92.3% versus 100% (p = 0.046) and 92.3% and 98.7% (p = 0.18). Complication rates were 12.2% and 44.2%, respectively (p < 0.0001). In group 2, the parametrial invasion rate in this study was 1.30%.
  
  
  CONCLUSIONS
  In our study, the two strategies are comparable in terms of DFS. Complications seem more frequent in the group 2, but more severe in the group 1. Finally, the low rate of parametrial invasion in group 2 confirms the interest of a less radical surgical treatment in these stages with good prognosis.
authors.affiliation: Department of Gynecology and Obstetrics, Hospital of Limoges, France, 8 Avenue Dominique Larrey, 87042 Limoges Cedex, France; Department of Surgery, Institut Paoli Calmettes Cancer Center, 232, Boulevard Sainte-Marguerite, 13273 Marseille, France. Electronic address: aymlacorre@hotmail.fr.
authors.forename: A
authors.initials: A
authors.lastname: Lacorre
authors.affiliation: Department of Surgery, Oscar Lambret Center, 3 rue Frédérique Combemale, 59020 Lille, France. Electronic address: benmerlot@gmail.com.
authors.forename: B
authors.initials: B
authors.lastname: Merlot
authors.affiliation: Department of Surgery, Oscar Lambret Center, 3 rue Frédérique Combemale, 59020 Lille, France. Electronic address: charles.garabedian@gmail.com.
authors.forename: C
authors.initials: C
authors.lastname: Garabedian
authors.affiliation: Department of Surgery, Oscar Lambret Center, 3 rue Frédérique Combemale, 59020 Lille, France. Electronic address: f-narducci@o-lambret.fr.
authors.forename: F
authors.initials: F
authors.lastname: Narducci
authors.affiliation: Department of Surgery, Institut Paoli Calmettes Cancer Center, 232, Boulevard Sainte-Marguerite, 13273 Marseille, France. Electronic address: chereaue@ipc.unicancer.fr.
authors.forename: E
authors.initials: E
authors.lastname: Chereau
authors.affiliation: Department of Radiation Oncology, Institut Paoli Calmettes Cancer Center, 232, Boulevard Sainte-Marguerite, 13273 Marseille, France. Electronic address: resbeutm@ipc.unicancer.fr.
authors.forename: M
authors.initials: M
authors.lastname: Resbeut
authors.affiliation: Department of Radiation Oncology, Institut Paoli Calmettes Cancer Center, 232, Boulevard Sainte-Marguerite, 13273 Marseille, France. Electronic address: minsatm@ipc.unicancer.fr.
authors.forename: M
authors.initials: M
authors.lastname: Minsat
authors.affiliation: Department of Surgery, Oscar Lambret Center, 3 rue Frédérique Combemale, 59020 Lille, France. Electronic address: leblanc@o-lambret.fr.
authors.forename: E
authors.initials: E
authors.lastname: Leblanc
authors.affiliation: Department of Surgery, Institut Paoli Calmettes Cancer Center, 232, Boulevard Sainte-Marguerite, 13273 Marseille, France. Electronic address: houvenaeghelg@ipc.unicancer.fr.
authors.forename: G
authors.initials: G
authors.lastname: Houvenaeghel
authors.affiliation: Department of Surgery, Institut Paoli Calmettes Cancer Center, 232, Boulevard Sainte-Marguerite, 13273 Marseille, France. Electronic address: lambaudiee@ipc.unicancer.fr.
authors.forename: E
authors.initials: E
authors.lastname: Lambaudie
mesh_terms: D000367:Age Factors; D000368:Aged; D001918:Brachytherapy / Q000379:methods* / Q000401:mortality; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods* / Q000401:mortality; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology; D009367:Neoplasm Staging; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*
keywords: Early stage cervical cancer; Morbidity; Overall and disease-free survival; Radical surgery; Radiosurgical treatment