Outcome of early stage cervical cancer patients treated according to a radiosurgical approach: Clinical results and prognostic factors

Objective To report clinical results of a multimodal strategy based on preoperative brachytherapy followed with surgery in early stage cervical cancer. Materials/Methods 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 >2 cm) between 2000 and 2013 was analyzed. The treatment consisted of preoperative low dose or pulse dose-rate utero-vaginal brachytherapy followed, 6–8 weeks 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. Results 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 5.3 years, 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 ≥3 cm (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 > 10 weeks 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. Conclusions A preoperative brachytherapy is a safe and effective option in early stage cervical cancer.