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

Abstract

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.

Comparison of survival outcomes of neoadjuvant therapy and direct surgery in IB2/IIA2 cervical adenocarcinoma: a retrospective study

“…However, in several retrospective studies, neoadjuvant brachytherapy and chemotherapy followed by RS for stage IB2 and IIA cervical cancer patients had no obvious inferiority to NACT + RS [31,32]. Additionally, Vízkeleti et al observed that the postoperative response rate in patients who received preoperative intrauterine brachytherapy was higher than that in patients who received RS alone (P = 0.03), and the rate of positive surgical margins was significantly lower (P = 0.02) [33]. This suggests that the underlying reason for our results is that radiotherapy and neoadjuvant brachytherapy reduce the pathological response in cervical AC.…”

Outcomes of pre-operative brachytherapy followed by hysterectomy for early cervical cancer

“…However, the National Comprehensive Cancer Network guidelines only recommend primary surgery followed by radiotherapy, depending on the prognostic factors detected in the surgical specimen 4. Nevertheless, image-guided brachytherapy is effective for delivering high radiation doses to cervical cancer tumors while limiting the dose delivered to organs at risk, and available retrospective data suggest that pre-operative brachytherapy is a safe and effective treatment 6–11. Therefore, this study aimed to describe the experience at our academic center, where early stage cervical cancer is treated using pre-operative brachytherapy followed by Wertheim-type hysterectomy, and to determine which patients might benefit from this strategy.…”

Effects of preoperative radiotherapy or chemoradiotherapy on postoperative pathological outcome of cervical cancer——from the large database of 46,313 cases of cervical cancer in China

“…Their results suggest that preoperative radiotherapy does not improve postoperative pathology. J. Vízkeleti et al [16] conducted a prospective study between 2005 and 2010. Fifty patients were retrospectively included in the PR and SD groups.…”

“…The results showed that preoperative radiotherapy significantly increased the rate of pathological complete remission. J. Vízkeleti, G. Frhlich, S. Varga, [10] and C. Polg ar et al conducted a prospective multicentre study in 2005. Their results showed that postoperative pathological complete remission was significantly higher in the PR group than in the SD group (25.7% vs 11.4%), while there was no significant difference in local tumour control (LTC), distant metastasis-free survival (DMFS) or overall survival (OS) between the two arms.…”

“…Tongqing Zhang believes that preoperative radiotherapy does not improve postoperative pathology results [9]. Vizkeleti et al believe that preoperative radiotherapy significantly increases the rate of pathological complete remission and decreases the rate of positive surgical margins [10]. In these studies, although the effect of preoperative radiotherapy or chemoradiotherapy on postoperative pathological outcomes was demonstrated, the deficient number of patients and inconsistent results impact the credibility of the articles.…”