Preoperative image-guided brachytherapy in early stage cervical cancers. Issue 3 (September 2016)

• Record Type: Journal Article
• Authors: Escande, Alexandre; Mazeron, Renaud; Gouy, Sebastien; Bentivegna, Enrica; Maroun, Pierre; Fahra, Georges; Oberlander, Anne-Sophie; Dumas, Isabelle; Castelnau-Marchand, Pauline; Deutsch, Eric; Morice, Philippe; Haie-Meder, Christine; Chargari, Cyrus
• Is Part Of: Radiotherapy and oncology. Volume 120:Issue 3(2016:Sep.)
• Page Start: 455
• Page End: 459
• Publication Date: 2016-09
• Subjects: Utero-vaginal brachytherapy -- Early stage cervical cancer -- IB1 -- IIA -- Image-guided brachytherapy; Oncology -- Periodicals; Radiotherapy -- Periodicals; Tumors -- Periodicals; Medical Oncology -- Periodicals; Neoplasms -- radiotherapy -- Periodicals; Radiotherapy -- Periodicals; Radiothérapie -- Périodiques; Cancérologie -- Périodiques; Tumeurs -- Périodiques; Electronic journals; 616.9940642
• DOI: 10.1016/j.radonc.2016.07.003
• Languages: English
• ISSNs: 0167-8140

Abstract

Abstract: Objective: To examine the clinical results of a preoperative image-guided pulse-dose-rate brachytherapy (PDR-BT) in early stage cervical cancer. Materials/methods: 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 > 2 cm). The objective was to deliver 60 Gy to 100% of the intermediate risk clinical target volume. Brachytherapy was followed, 6–8 weeks later, by a radical hysterectomy/bilateral salpingo-oophorectomy plus pelvic +/− para-aortic lymph node dissection. Patients with positive lymph nodes had postoperative chemoradiation. Results: 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 ⩾ 1 cm. Median follow-up was 46.8 months. 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 > 3 cm and a brachytherapy/surgery time interval ⩾ 9 weeks correlated with a poorer DFS. Six postoperative complications were encountered (7.8%). Total reference air kerma correlated with late vaginal toxicity ( p = 0.02). Conclusions: A preoperative image-guided PDR-BT was safe and effective. Predictive factors for survival and toxicity were evidenced.