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Journal Article Ppublish 2 citations

PubMed: 37788511 DOI: 10.1016/j.ejogrb.2023.09.021

Brachytherapy and surgery versus surgery alone for IB2 (FIGO 2018) cervical cancers: A FRANCOGYN study.

Eur J Obstet Gynecol Reprod Biol 290:128-134

Authors: Othman Aissaoui, Jérôme Phalippou, Abel Cordoba, Henri Azais, Lobna Ouldamer, Pierre Adrien Bolze, Marcos Ballester, Cyrille Huchon, Camille Mimoun, Cherif Akladios, Lise Lecointre, Emilie Raimond, Olivier Graesslin, Xavier Carcopino, Vincent Lavoué, Sofiane Bendifallah, Cyril Touboul, Yohann Dabi, Geoffroy Canlorbe, Martin Koskas, Pauline Chauvet, Pierre Collinet, Yohan Kerbage

Affiliations

  • CHU Lille, Service de chirurgie gynécologique, F-59000 Lille, France; Univ. Lille, CHU Lille, F-59000 Lille, France.
  • CHU Lille, Service de chirurgie gynécologique, F-59000 Lille, France.
  • Radiation Oncology and Brachytherapy Department, Centre Oscar Lambret, Lille, France.
  • AP-HP.CUP, Service de chirurgie cancérologique gynécologique et du sein, Hôpital Européen Georges-Pompidou, Paris, France.
  • Department of Gynaecology. CHRU de Tours. Hôpital Bretonneau. INSERM Unit, 1069, 2 boulevard Tonnellé 37044 TOURS, France.
  • Department of Gynaecologic and Oncologic Surgery and Obstetrics, Centre Hospitalier Universitaire Lyon Sud, Hospices Civils de Lyon, Université Lyon 1, France.
  • Department of Gynaecologic and Breast Surgery, Groupe Hospitalier Diaconesses Croix Saint Simon, 125 rue d'Avron, 75020 Paris, France.
  • APHP. Service de gynécologie & obstétrique, GH Saint-Louis Lariboisière-Fernand Widal, Hôpital Lariboisière, Université de Paris, 2, rue Ambroise Paré, 75010 Paris, France.
  • APHP. Service de gynécologie & obstétrique, GH Saint-Louis Lariboisière-Fernand Widal, Hôpital Lariboisière, Université de Paris, 2, rue Ambroise Paré, 75010 Paris, France.
  • Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
  • Department of Gynecologic Surgery, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.
  • Department of Obstetrics and Gynaecology, Alix de Champagne Institute, Centre Hospitalier Universitaire, 45 rue Cognacq-Jay, 51092 Reims, France.
  • Department of Obstetrics and Gynaecology, Hôpital Nord, APHM, Aix-Marseille University (AMU), Univ Avignon, CNRS, IRD, IMBE UMR 7263, 13397 Marseille, France.
  • Department of Gynaecology, CHU de Rennes, France; INSERM, 1242, COSS, Rennes, Université de Rennes 1, France.
  • Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France.
  • Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France.
  • Department of Gynaecology and Obstetrics, Tenon University Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Faculté de Médecine Sorbonne Université, Institut Universitaire de Cancérologie (IUC), France.
  • Department of Gynecologic and Breast Surgery and Oncology, Hôpital la Pitié Salpétrière, AP-HP Paris, France.
  • Department of Gynaecology and Obstetrics, Hôpital Bichat, AP HP, France.
  • Department of Gynaecology and Obstetrics, CHU de Clermont Ferrand, France.
  • CHU Lille, Service de chirurgie gynécologique, F-59000 Lille, France; Univ. Lille, CHU Lille, F-59000 Lille, France.
  • CHU Lille, Service de chirurgie gynécologique, F-59000 Lille, France; Univ. Lille, CHU Lille, F-59000 Lille, France.

Abstract

OBJECTIVE

Evaluation of the management by first brachytherapy followed by radical hysterectomy (Wertheim type) compared to radical hysterectomy alone (Wertheim type) for the treatment of IB2 cervical cancer.

METHODS

Data from women with histologically proven FIGO stage IB2 cervical cancer treated between April 1996 and December 2016 were retrospectively abstracted from twelve French institutions with prospectively maintained databases.

RESULTS

Of the 211 patients with FIGO stage IB2 cervical cancer without lymph node involvement included, 136 had surgical treatment only and 75 had pelvic lymph node staging and brachytherapy followed by surgery. The surgery-only group had significantly more adjuvant treatment (29 vs. 3; p = 0.0002). A complete response was identified in 61 patients (81%) in the brachytherapy group. Postoperative complications were comparable (63,2% vs. 72%, p = 0,19) and consisted mainly of urinary (36vs. 27) and digestive (31 vs 22) complications and lymphoceles (4 vs. 1). Brachytherapy had no benefit in terms of progression-free survival (p = 0.14) or overall survival (p = 0.59). However, for tumors of between 20 and 30 mm, preoperative brachytherapy improved recurrence-free survival (p = 0.0095) but not overall survival (p = 0.41). This difference was not observed for larger tumors in terms of either recurrence-free survival (p = 0.55) or overall survival (p = 0.95).

CONCLUSION

Our study found that preoperative brachytherapy had no benefit for stage IB2 cervical cancers in terms of recurrence-free survival or overall survival. For tumor sizes between 2 and 3 cm, brachytherapy improves progression-free survival mainly by reducing pelvic recurrences without improving overall survival.

MeSH

Reproduction, Lymph Nodes, Progression-Free Survival, Hysterectomy, Uterine Cervical Neoplasms, Brachytherapy, Neoplasms, Obstetrics, Lymph, Gynecology, Therapeutics