Brachytherapy versus radical hysterectomy after external beam chemoradiation: a non-randomized matched comparison in IB2-IIB cervical cancer patients

Abstract

Background: A current paradigm in the treatment of cervical cancer with radiation therapy is that intracavitary brachytherapy is an essential component of radical treatment. This is a matched retrospective comparison of the results of treatment in patients treated with external beam chemoradiation (EBRT-CT) and radical hysterectomy versus those treated with identical chemoradiation followed by brachytherapy.

Value of Magnetic Resonance and 18FDG PET-CT in Predicting Tumor Response and Resectability of Primary Locally Advanced Cervical Cancer After Treatment With Intensity-Modulated Arc Therapy

“…This is at least comparable to published data. 14,20,35 Although MRI is considered almost as a necessity in modern radiotherapy planning for cervical cancer, 36,37 its value in staging is only recently been prudently appreciated by the editorial office of the FIGO, 38 although accuracy has already been shown to be as high as 90% more than a decade ago. 39 Although the American College of Radiology Imaging Network Intergroup study recognized the low accuracy of MRI to diagnose minimal parametrial extent, 18 this does not apply to our patients because parametrial extent was bulky in all our patients with stage IIB disease.…”

“…11Y13 In stage IB2 to IIB disease, brachytherapy is dispensable provided that radical hysterectomy with pelvic lymphadenectomy is performed. 14 At Gent University Hospital, combined cisplatin-IMAT (IMAT-C) followed by extrafascial hysterectomy (EH) gives excellent local control of FIGO IIB-IVA cervical cancer. 15 The decision about EH is made multidisciplinary and depends on local response diagnosed clinically and by magnetic resonance imaging (MRI) and 2-deoxy-2- [18] fluoro-Dglucose positron emission tomography computed tomography ( 18 FDG PET-CT) as suggested in the literature.…”

Comparison of Neoadjuvant Chemotherapy Followed by Radical Hysterectomy and Neoadjuvant Chemoradiation Followed by Radical Hysterectomy with Concurrent Chemoradiation in Locally Advanced Carcinoma Cervix (FIGO Stages IB2, IIA2, IIB): Interim Results of a Randomized Control Study

“…Similarly, a prospective analysis performed by Huguet et al, in which all the patients were given a tumor-free resection margins 19 and at histological assessment complete response was recognized in 54.5%, cervical microscopic disease with significant tumour cells <5 mm in dimension was identified in 17,5% and cervical residual disease >5 mm in dimension was identified in 28% of patients. However, when zero vaginal, as well as the parametrial residual disease, was noted which is similar to our study results.…”

Patient age, tumor appearance and tumor size are risk factors for early recurrence of cervical cancer

“…Chemotherapy enhances the radiosensitivity of tumor cells for better local control and also controls potential distant tumor metastasis. If the patients fail to show local control following radiotherapy, surgical removal of local tumor lesions should be considered, which may help control tumor progression, reduce recurrence and improve patient outcome (19)(20)(21). These reasons may explain why patient age, tumor appearance and tumor size are independent factors for cervical cancer recurrence and they should be considered for future management of cervical cancer.…”