title: Outcome of early stage cervical cancer patients treated according to a radiosurgical approach: Clinical results and prognostic factors.
abstract: To report clinical results of a multimodal strategy based on preoperative brachytherapy followed with surgery in early stage cervical cancer.
  
  
  
  The outcome of consecutive patients receiving brachytherapy in our Institution for an early stage IB1-IIA1 invasive cervical cancer with risk factors (lymphovascular embols and/or tumor >2cm) between 2000 and 2013 was analyzed. The treatment consisted of preoperative low dose or pulse dose-rate utero-vaginal brachytherapy followed, 6-8weeks later, by a radical hysterectomy/bilateral salpingo-oophorectomy plus pelvic±para-aortic lymph node dissection. A postoperative chemoradiation was delivered in patients with histological evidence of lymph nodes metastases.
  
  
  
  182 patients were identified. Histological examination of hysterectomy specimen showed the presence of a tumor residuum in 55 patients (30.2%). One patient (0.5%) had residual tumor cells in the parametria. With a median follow-up of 5.3years, 14 patients (7.7%) presented tumor relapse, including three (1.6%) local relapses. Five-year disease-free survival (DFS) rate was 93.6% (95%CI: 91.6-95.6%). In log-rank analysis, presence of pelvic nodal metastases at time of lymphadenectomy (p=0.001) and tumor size ≥3cm (p=0.003) correlated with a poorer DFS. Presence of a tumor residuum on hysterectomy specimen correlated with a higher risk of pelvic or para-aortic failure (p=0.035). A time interval>10weeks between brachytherapy and surgery correlated with a higher risk of failure outside the pelvis (p=0.003). Significant postoperative complications were reported in 16 patients (8.8%). All delayed toxicities were mild to moderate.
  
  
  
  A preoperative brachytherapy is a safe and effective option in early stage cervical cancer.
authors.affiliation: Department of Radiotherapy, Brachytherapy Unit, Gustave Roussy Cancer Campus, France.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Escande
authors.affiliation: Department of Surgery, Gustave Roussy Cancer Campus, France.
authors.forename: Sebastien
authors.initials: S
authors.lastname: Gouy
authors.affiliation: Department of Radiotherapy, Brachytherapy Unit, Gustave Roussy Cancer Campus, France.
authors.forename: Renaud
authors.initials: R
authors.lastname: Mazeron
authors.affiliation: Department of Surgery, Gustave Roussy Cancer Campus, France.
authors.forename: Enrica
authors.initials: E
authors.lastname: Bentivegna
authors.affiliation: Department of Radiotherapy, Brachytherapy Unit, Gustave Roussy Cancer Campus, France.
authors.forename: Warren
authors.initials: W
authors.lastname: Bacorro
authors.affiliation: Department of Radiotherapy, Brachytherapy Unit, Gustave Roussy Cancer Campus, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Maroun
authors.affiliation: Department of Radiotherapy, Brachytherapy Unit, Gustave Roussy Cancer Campus, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Schernberg
authors.affiliation: Department of Radiotherapy, Brachytherapy Unit, Gustave Roussy Cancer Campus, France.
authors.forename: Anne-Sophie
authors.initials: AS
authors.lastname: Oberlander
authors.affiliation: Department of Radiotherapy, Brachytherapy Unit, Gustave Roussy Cancer Campus, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Dumas
authors.affiliation: Department of Pathology, Gustave Roussy Cancer Campus, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Genestie
authors.affiliation: 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.
authors.forename: Eric
authors.initials: E
authors.lastname: Deutsch
authors.affiliation: Department of Surgery, Gustave Roussy Cancer Campus, France; University Paris-Sud, SIRIC SOCRATES, Faculté de Médecine, Le Kremlin-Bicetre, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Morice
authors.affiliation: Department of Radiotherapy, Brachytherapy Unit, Gustave Roussy Cancer Campus, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Haie-Meder
authors.affiliation: 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.
authors.forename: Cyrus
authors.initials: C
authors.lastname: Chargari
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001918:Brachytherapy / Q000379:methods*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D012189:Retrospective Studies; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D055815:Young Adult
keywords: Early stage cervical cancer; Hysterectomy; Preoperative brachytherapy