Preoperative brachytherapy followed by laparoscopic hysterectomy: a new
option to consider for early stages cervical cancer in the light of the
LACC trial results
Abstract
OBJECTIVES This study aims to report the outcomes of the combination of
preoperative brachytherapy (POBT) followed by a Querleu Morrow Type A
hysterectomy as an alternative to upfront surgery for early stage
cervical cancer (ESCC) (2018 FIGO IA1-IB2). METHODS A single center
retrospective study conducted between 2001 and 2012. After confirming
the absence of pelvic node metastasis, all patients with ESCC underwent
Low Dose Rate (LDR) POBT followed by Type A hysterectomy. Primary and
secondary endpoints were the Disease Free Survival (DFS) and the
associated morbidity respectively. RESULTS Out of the 138 patients
included, complete response was found in 49.3 % and a residual tumor
< 1 cm in 26 %. After a median follow up of 132 months, DFS
was 93.5% and 9 recurrences occurred. In univariate analysis, we found
that delaying surgery more than 52 days after POBT is associated with a
significant decrease in DFS (p = 0.004). Pathological complete response
was associated with an increased DFS (p = 0.03). The brachytherapy
related rate of late complications was 17.3% (n=24) and the surgery
related urinary tract complications rate was 6.5% (n=9), with only 2
patients (1.5%) presented grade 3 complications CONCLUSION The
multimodal radio-surgical management of ESCC appears to be a reasonable
alternative to upfront open radical hysterectomy particularly in
patients with high risk ESCC (< 2cm associated with negative
prognostic factors or for tumors measuring between 2 and 4cm). This
approach is associated with low complications rate and a reasonable rate
of local recurrences.