Operable Stages IB and II cervical carcinomas: a retrospective study comparing preoperative uterovaginal brachytherapy and postoperative radiotherapy

Atlan, D; Touboul, E.; Deniaud-Alexandre, É.; Lefranc, Jean‐Pierre; Antoine, Jean-Marie; Jannet, D.; Lhuillier, Pierre; Uzan, M.; Huart, Judith; Genestie, Catherine; Antoine, Martine; Jamali, Maryam; Ganansia, V.; Milliez, Jacques; Uzan, Serge; J, Blondon

doi:10.1016/s0360-3016(02)02971-1

Cited by 32 publications

(25 citation statements)

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“…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.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Discussionmentioning

confidence: 99%

“…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. The majority of these studies concluded that in patients with pCR obtained by preoperative BT the LTC and the OS was better than in cases that showed minimal or no regression to RT [4,5,7,19]. However, most of the studies that deal with the effect of preoperative RT are retrospective, with no control group, so there is no direct comparison between the results of surgery alone versus preoperative BT followed by surgery.…”

Section: Discussionmentioning

confidence: 99%

“…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].…”

Section: Introductionmentioning

confidence: 99%

“…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].…”

Section: Introductionmentioning

confidence: 99%

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

Vízkeleti

Vereczkey

Fröhlich

et al. 2014

Pathol. Oncol. Res.

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The role of preoperative intrauterine brachytherapy (BT) in the multidisciplinary treatment of early stage cervical carcinoma (ESCC) is controversial. In 2005, a prospective randomized multicenter study was initiated in Hungary in order to explore the potential advantages of preoperative high-dose-rate (HDR) BT. In this article we evaluate the efficiency of preoperative HDR BT by the rate of pathologic complete remission (pCR) in the first 185 patients enrolled in the study at the National Institute of Oncology and at the Uzsoki Municipal Cancer Center in collaboration with the 1st Department of Gynaecology and Obstetrics of Semmelweis University, Budapest, Hungary. In arm A, patients received 2x8Gy preoperative intracavitary HDR BT, while in arm B no preoperative treatment was given. In both arms patients underwent radical Wertheim (Piver III) hysterectomy. The pCR rate was 25.7% after preoperative HDR BT, while it was only 11.2% with surgery alone (p=0.03), in these cases the tumor was eliminated during the diagnostic excision or conisation. The rate of positive surgical margins was 1.5% after preoperative BT, while it was as high as 11.4% without preoperative RT (p=0.02). There was no significant difference in the local tumor control (LTC), distant metastases free survival (DMFS) and overall survival (OS) between the two arms. According to our preliminary results preoperative intracavitary HDR BT significantly increases the rate of pCR and decreases the rate of positive surgical margins in patients with ESCC. Longer follow-up is required to establish the possible impact of pCR on the ultimate LTC and OS.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

Vízkeleti

Vereczkey

Fröhlich

et al. 2014

Pathol. Oncol. Res.

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Type II or type III radical hysterectomy compared to chemoradiotherapy as a primary intervention for stage IB2 cervical cancer

Nama

Murdoch

Bailey

2018

Cochrane Database of Systematic Reviews

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Sentinel lymph nodes

Barranger

Daraı̈

2003

Cancer

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M eric et al. 1 recently concluded that currently available data are not sufficient to determine conclusively whether distant metastases are caused by the development of ipsilateral breast tumor recurrence (IBTR). 1 The authors of at least four randomized, prospective trials do not agree. 2-5 For example, the National Surgical Adjuvant Breast and Bowel Project (NSABP) concluded that local recurrence is a marker for risk (and not a cause) of distant metastases. 2 Meric et al. also concluded that it would be difficult to argue biologically that malignant cells in the primary tumor could metastasize and affect survival while arguing that malignant cells in the recurrent tumor could not. I have offered this explanation. 6 It is likely that cancer cells begin to circulate when a tumor is very small. Cells shed from a small tumor may succumb to a variety of host defense factors-mechanical, biochemical, immunologic, etc. After breast-conserving surgery, cancer may recur locally. (Here, I prefer the term local persistence.) Patients who survive their first cancer without developing distant metastases may be expected to survive the recurrence of a similar volume of tumor, because the host defense factors that killed tumor cells from the primary tumor can be expected to kill tumor cells shed from the recurrence (persistence). Local recurrence after radical surgery has always been an ominous event. It may represent the return of malignant cells from a distant organ to the site of surgery. Local recurrence also may occur after breast-conserving surgery. This is one reason why patients who develop IBTR have a poorer prognosis compared with patients who do not. In NSABP trial B-06, patients who developed local recurrence were 3.41 times as likely to also develop distant metastases. 2 This is not evidence that IBTR is the cause of tumor spread. Investigators from the NSABP trial B-06 recently reported a marginally significant decrease in breast cancer deaths among women who received postoperative radiotherapy. 7 This finding is fully compatible with the above hypothesis. The excess deaths in the unirradiated group may have occurred in women whose recurrences exceeded their primary tumors in terms of volume. I asked the NSABP for data on the size of tumor recurrences and was told that such data are not available. Meric et al. discussed the possible survival advantage associated with local control. They cited important studies that will help us fine-tune our understanding of this dilemma. However, the past 15 years have witnessed a dramatic change in our understanding of local recurrence. Local persistence seldom metastasizes in patients with the soft tissue sarcomas, rectal carcinoma, melanoma, and other solid tumors.

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Operable Stages IB and II cervical carcinomas: a retrospective study comparing preoperative uterovaginal brachytherapy and postoperative radiotherapy

Cited by 32 publications

References 75 publications

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

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

Type II or type III radical hysterectomy compared to chemoradiotherapy as a primary intervention for stage IB2 cervical cancer

Sentinel lymph nodes

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