1. Preoperative image-guided brachytherapy in early stage cervical cancers
- Author
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Philippe Morice, Anne-Sophie Oberlander, Renaud Mazeron, P. Castelnau-Marchand, Enrica Bentivegna, Christine Haie-Meder, Isabelle Dumas, Alexandre Escande, Cyrus Chargari, Sebastien Gouy, Pierre Maroun, Georges Fahra, and Eric Deutsch
- Subjects
Adult ,medicine.medical_specialty ,Adolescent ,medicine.medical_treatment ,Brachytherapy ,Uterine Cervical Neoplasms ,Hysterectomy ,030218 nuclear medicine & medical imaging ,Young Adult ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Radical Hysterectomy ,Stage (cooking) ,Lymph node ,Neoadjuvant therapy ,Survival analysis ,Aged ,Neoplasm Staging ,Retrospective Studies ,Cervical cancer ,business.industry ,Radiotherapy Dosage ,Hematology ,Middle Aged ,Prognosis ,medicine.disease ,Survival Analysis ,Neoadjuvant Therapy ,Surgery ,medicine.anatomical_structure ,Oncology ,Lymphatic Metastasis ,030220 oncology & carcinogenesis ,Lymph Node Excision ,Female ,Radiotherapy, Adjuvant ,Neoplasm Recurrence, Local ,business ,Radiotherapy, Image-Guided - 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>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. 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⩾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). Conclusions A preoperative image-guided PDR-BT was safe and effective. Predictive factors for survival and toxicity were evidenced.
- Published
- 2016