Combined brachytherapy and surgery for early carcinoma of the uterine cervix: analysis of extent of surgery on outcome

Pathologic Complete Remission after Preoperative High-Dose-Rate Brachytherapy in Patients with Operable Cervical Cancer: Preliminary Results of a Prospective Randomized Multicenter Study

“…At the same time, the rate of high-risk patients who needed postoperative RChT was 11.1 % less in the pre-irradiated arm. Other studies [4,5,9] also support the idea that with preoperative BT in some of the patients postoperative pelvic irradiation, responsible for most of the bladder and bowel complications, can be spared. In a series of 162 cases of stage IB1 cervical cancer treated with 60Gy preoperative uterovaginal BT followed by laparoscopic radical hysterectomy (LRH) [24], the need for postoperative adjuvant RChT was 7 %, compared to 24 % in the series reported by Pellegrino et al [25], including exclusively stage IB1 disease, or 66 % reported by Puntambekar et al [26], including stage IA2 and IB1 patients, who underwent LRH and pelvic LAD.…”

“…In principle, the aim of preoperative RT is to achieve partial or complete pathologic remission of the tumor (downsizing, eventually downstaging), to increase the probability of ablastic surgery, thus decreasing or eliminating the need for adjuvant RT [4,5,9]. We summarized the results of several retrospective studies from the literature regarding the effect of preoperative BT in Table 6.…”

“…We summarized the results of several retrospective studies from the literature regarding the effect of preoperative BT in Table 6. With higher doses (39-75 Gy) of low-dose-rate (LDR) or HDR BT the pCR rate was from 52-88 %, while with lower doses of HDR BT the same proportion was 23-45 % [4,5,[8][9][10][11]13,17,18]. In certain institutions in more advanced stages (I/B2-II/B) the preoperative treatment is combined RT (tele+brachytherapy), with or without concomitant ChT, followed by adjuvant hysterectomy.…”

“…However, there is no general consensus regarding the optimal treatment of stage IA2, IB1, IB2, IIA1, IIA2, and proximal IIB diseases. Certain institutions, mainly in France and Sweden, perform RT before the surgical intervention, while in Anglo-Saxon countries primary surgery is preferred, followed by postoperative RT, or RChT in selected patients [3][4][5][6][7][8][9].…”

“…However, in the absence of prospective randomized studies, there is no level I-II evidence regarding the advantages or eventual disadvantages of preoperative BT. Several retrospective single-institution single-arm studies (evidence level III-IV) evaluate the outcomes of surgery alone or BT followed by surgery, but these results are not directly comparable and are often contradictory [4][5][6][7][8][9][10][11][12][13][14][15][16].…”