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

doi:10.1186/1477-7819-7-19

World Journal of Surgical Oncology

Volume 7

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Cetina L
Garcia-Arias A
Candelaria M
Cantú D
Rivera L
Coronel J
Bazan-Perkins B
Flores V
Gonzalez A
Dueñas-González A

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Cetina L
Garcia-Arias A
Candelaria M
Cantú D
Rivera L
Coronel J
Bazan-Perkins B
Flores V
Gonzalez A
Dueñas-González A
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Research

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

Lucely Cetina¹ , Alicia Garcia-Arias¹ , Myrna Candelaria¹ , David Cantú² , Lesbia Rivera³ , Jaime Coronel¹ , Blanca Bazan-Perkins¹ , Vladimir Flores¹ , Aaron Gonzalez² and Alfonso Dueñas-González⁴

¹Division of Clinical Research, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico

²Department of Gynecological Oncology, INCan, Mexico City, Mexico

³Division of Radiation Oncology, INCan, Mexico City, Mexico

⁴Unit of Biomedical Research on Cancer, Instituto de Investigaciones Biomédicas (IIB), Universidad Nacional Autónoma de México (UNAM)/INCan, Mexico City, México

author email corresponding author email

World Journal of Surgical Oncology 2009, 7:19doi:10.1186/1477-7819-7-19


Published:	16 February 2009

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.

Methods

In this non-randomized comparison EBRT-CT protocol was the same in both groups of 40 patients. In the standard treated patients, EBRT-CT was followed by one or two intracavitary Cesium (low-dose rate) applications within 2 weeks of finishing external radiation to reach a point A dose of at least 85 Gy. In the surgically treated patients, radical hysterectomy with bilateral pelvic lymph node dissection and para-aortic lymph node sampling were performed within 7 weeks after EBRT-CT. Response, toxicity and survival were evaluated.

Results

A total of 80 patients were analyzed. The patients receiving EBRT-CT and surgery were matched with the standard treated cases. There were no differences in the clinicopathological characteristics between groups or in the delivery of EBRT-CT. The pattern of acute and late toxicity differed. Standard treated patients had more chronic proctitis while the surgically treated had acute complications of surgery and hydronephrosis. At a maximum follow-up of 60 months, median follow-up 26 (2–31) and 22 (3–27) months for the surgery and standard therapy respectively, eight patients per group have recurred and died. The progression free and overall survival are the same in both groups.

Conclusion

The results of this study suggest that radical hysterectomy can be used after EBRT-CT without compromising survival in FIGO stage IB2-IIB cervical cancer patients in settings were brachytherapy is not available. A randomized study is needed to uncover the value of surgery after EBRT-CT.