Preoperative image-guided brachytherapy in early stage cervical cancers.
To examine the clinical results of a preoperative image-guided pulse-dose-rate brachytherapy (PDR-BT) in early stage cervical cancer.



We examined the outcome of consecutive patients with early stage cervical cancer undergoing preoperative image-guided PDR-BT between 2004 and 2013 because of risk factors (lymphovascular embols and/or tumour>2cm). The objective was to deliver 60Gy to 100% of the intermediate risk clinical target volume. Brachytherapy was followed, 6-8weeks later, by a radical hysterectomy/bilateral salpingo-oophorectomy plus pelvic +/- para-aortic lymph node dissection. Patients with positive lymph nodes had postoperative chemoradiation.



77 patients met the above criteria of preoperative PDR-BT. On hysterectomy specimen, 54 (70.1%) presented a complete histological response. Four (5.2%) had a tumour residuum⩾1cm. Median follow-up was 46.8months. 5-Year disease-free survival (DFS) rate was 84.4%. Only one local recurrence was observed. The presence of lymph nodal metastases, a tumour size>3cm and a brachytherapy/surgery time interval⩾9weeks correlated with a poorer DFS. Six postoperative complications were encountered (7.8%). Total reference air kerma correlated with late vaginal toxicity (p=0.02).



A preoperative image-guided PDR-BT was safe and effective. Predictive factors for survival and toxicity were evidenced.
Department of Radiotherapy, Brachytherapy Unit, Gustave Roussy Cancer Campus, France.
Alexandre
A
Escande
Department of Radiotherapy, Brachytherapy Unit, Gustave Roussy Cancer Campus, France.
Renaud
R
Mazeron
Department of Surgery, Gustave Roussy Cancer Campus, France.
Sebastien
S
Gouy
Department of Surgery, Gustave Roussy Cancer Campus, France.
Enrica
E
Bentivegna
Department of Radiotherapy, Brachytherapy Unit, Gustave Roussy Cancer Campus, France.
Pierre
P
Maroun
Department of Radiotherapy, Brachytherapy Unit, Gustave Roussy Cancer Campus, France.
Georges
G
Fahra
Department of Radiotherapy, Brachytherapy Unit, Gustave Roussy Cancer Campus, France.
Anne-Sophie
AS
Oberlander
Department of Radiotherapy, Brachytherapy Unit, Gustave Roussy Cancer Campus, France.
Isabelle
I
Dumas
Department of Radiotherapy, Brachytherapy Unit, Gustave Roussy Cancer Campus, France.
Pauline
P
Castelnau-Marchand
Department of Radiotherapy, Brachytherapy Unit, Gustave Roussy Cancer Campus, France; University Paris-Sud, SIRIC SOCRATES, Faculté de Médecine, Le Kremlin-Bicetre, France; INSERM 1030, Gustave Roussy Cancer Campus, France.
Eric
E
Deutsch
Department of Surgery, Gustave Roussy Cancer Campus, France; University Paris-Sud, SIRIC SOCRATES, Faculté de Médecine, Le Kremlin-Bicetre, France.
Philippe
P
Morice
Department of Radiotherapy, Brachytherapy Unit, Gustave Roussy Cancer Campus, France.
Christine
C
Haie-Meder
Department of Radiotherapy, Brachytherapy Unit, Gustave Roussy Cancer Campus, France; INSERM 1030, Gustave Roussy Cancer Campus, France; Institut de Recherche Biomédicale des Armées, Bretigny-sur-Orge, France; French Military Health Service Academy, Ecole du Val-de-Grâce, Paris, France. Electronic address: cyrus.chargari@gustaveroussy.fr.
Cyrus
C
Chargari
D000293:Adolescent; D000328:Adult; D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000473:pathology; D011379:Prognosis; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D061089:Radiotherapy, Image-Guided / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D016019:Survival Analysis; D002583:Uterine Cervical Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D055815:Young Adult
Early stage cervical cancer; IB1; IIA; Image-guided brachytherapy; Utero-vaginal brachytherapy