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Buchalet C, Loap P, Losa S, Laas E, Gaillard T, Lecuru F, Malhaire C, Huchet V, De La Rochefordiere A, Labib A, Kissel M. Long-term clinical outcomes of preoperative brachytherapy in early-stage cervical cancer. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108342. [PMID: 38636247 DOI: 10.1016/j.ejso.2024.108342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 04/09/2024] [Accepted: 04/12/2024] [Indexed: 04/20/2024]
Abstract
OBJECTIVE The treatment of early-stage cervical cancer (CC) is primarily based on surgery. Adjuvant (chemo)radiotherapy can be necessary in presence of risk factors for relapse (tumor size, deep stromal invasion, lymphovascular space invasion (LVSI), positive margins, parametrial or lymph node involvement), increasing the risk of treatment toxicity. Preoperative brachytherapy can reduce tumor extension before surgery, potentially limiting the need for adjuvant radiotherapy. This study reports long-term clinical outcomes on efficacy and toxicity of preoperative pulse-dose-rate (PDR) brachytherapy in early-stage CC. METHODS All patients treated at Institut Curie between 2007 and 2022 for early-stage CC by preoperative brachytherapy were included. A PDR technique was used. Patients underwent hysterectomy associated with nodal staging following brachytherapy. RESULTS 73 patients were included. The median time from brachytherapy to surgery was 45 days [range: 25-78 days]. With a median follow-up of 51 months [range: 4-185], we reported 3 local (4 %), 1 locoregional (1 %) and 8 metastatic (11 %) relapses. At 10 years, OS was 84.1 % [95 % CI: 70.0-100], DFS 84.3 % [95 % CI:74.6-95.3] and LRFS 92.8 % [95 % CI:84.8-100]. Persistence of a tumor residue, observed in 32 patients (44 %), was a significant risk factor for metastatic relapse (p = 0.02) and was associated with the largest tumor size before brachytherapy (p = 0.04). Five patients (7 %) experienced grade 3 toxicity. One patient (1 %) developed grade 4 toxicity. Ten patients (14 %) received adjuvant radiotherapy, increasing the risk of lymphedema (HR 1.31, 95 % CI [1.11-1.54]; p = 0.002). CONCLUSIONS PDR preoperative brachytherapy for early-stage cervical cancer provides high long-term tumor control rates with low toxicity.
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Affiliation(s)
- C Buchalet
- Radiation Oncology Department, Institut Curie, Paris, France
| | - P Loap
- Radiation Oncology Department, Institut Curie, Paris, France
| | - S Losa
- Medical Physics Department, Institut Curie, Paris, France
| | - E Laas
- Surgical Oncology Department, Institut Curie, Paris, France
| | - T Gaillard
- Surgical Oncology Department, Institut Curie, Paris, France
| | - F Lecuru
- Surgical Oncology Department, Institut Curie, Paris, France
| | - C Malhaire
- Radiology Department, Institut Curie, Paris, France
| | - V Huchet
- Nuclear Medicine Department, Institut Curie, Paris, France
| | - A De La Rochefordiere
- Radiation Oncology Department, Centre Charlebourg-La Défense-Amethyst, La Garenne-Colombes, France
| | - A Labib
- Radiation Oncology Department, Institut Curie, Paris, France
| | - M Kissel
- Radiation Oncology Department, Institut Curie, Paris, France.
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Vieira-Serna S, Viveros-Carreño D, Rodríguez J, Grillo-Ardila CF, Angeles MA, Guerrero E, Sanabria D, Pareja R. Preoperative brachytherapy for early-stage cervical cancer: Systematic review and meta-analysis. Gynecol Oncol 2023; 169:4-11. [PMID: 36459858 DOI: 10.1016/j.ygyno.2022.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 11/08/2022] [Accepted: 11/09/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the rate of pathological response rate, and the oncological outcomes of preoperative brachytherapy (PBT) in early-stage cervical cancer. METHODS A systematic literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and meta-analyses (PRISMA) statement. MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Scopus databases were searched from inception until April 2022. Only English and French articles were included. Studies containing data about pathology response or oncological outcomes among patients who received PBT as compared to those who underwent up-front surgery in early-stage cervical cancer were included. This study was registered in PROSPERO (CRD42022319036). RESULTS Thirteen studies met the inclusion criteria, 3 randomized controlled trials (RCT), and 10 non-randomized studies (NRS). The 5-year survival was significantly higher in the PBT group compared with the up-front surgery group (OR 1.78, 95% CI 1.11-2.84, I2 = 0%) in the NRS. Recurrence rate was significantly lower in the PBT group compared with in up-front surgery group in the analysis of the RCT but not in NRS, (OR 0.34, 95% CI 0.13-0.91, I2 not applicable) and (OR 0.72, 95% CI 0.26-1.95, I2 = 51%) respectively. PBT was associated with a statistically significant lower rate of positive margins (OR 0.28, 95% CI 0.09-0.89; I2 = 42%) in the RCT and with a significantly higher rate of complete pathology response (CPR) in the RCT analysis (OR 2.55, 95% CI 1.11-5.85, I2 = 0%) and in the NRS (OR 9.64, 95% CI 1.88-49.48, I2 = 76%) compared with the up-front surgery group. CONCLUSION Preoperative brachytherapy in patients with early-stage cervical cancer could improve pathologic and oncologic outcomes, but it should be assessed in high-quality randomized controlled trials before its implementation in clinical practice.
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Affiliation(s)
- Santiago Vieira-Serna
- Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Bogotá́, Colombia; Universidad Militar Nueva Granada, Bogotá, Colombia.
| | - David Viveros-Carreño
- Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Bogotá́, Colombia; Department of Gynecologic Oncology, Clínica Universitaria Colombia and Centro de Tratamiento e Investigación sobre Cáncer Luis Carlos Sarmiento Angulo - CTIC: Bogotá, Colombia; Department of Gynecologic Oncology, Clínica Los Nogales, Bogotá, Colombia
| | - Juliana Rodríguez
- Department of Gynecology and Obstetrics, Section of Gynecologic Oncology, Fundación Santa Fe de Bogotá, Bogotá, Colombia; Cancer Clinical and Epidemiological Research Group, Instituto Nacional de Cancerología, Bogotá́, Colombia
| | - Carlos F Grillo-Ardila
- Cancer Clinical and Epidemiological Research Group, Instituto Nacional de Cancerología, Bogotá́, Colombia; Department Gynecology and Obstetrics, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Martina Aida Angeles
- Department of Surgical Oncology, Institut Claudius Regaud - Institut Universitaire du Cancer de Toulouse - Oncopole, Toulouse, France
| | - Eduardo Guerrero
- Department of Radiotherapy, Instituto Nacional de Cancerología, Bogotá́, Colombia
| | - Daniel Sanabria
- Department of Gynecology and Obstetrics, Section of Gynecologic Oncology, Fundación Santa Fe de Bogotá, Bogotá, Colombia; Department of Gynecology and Obstetrics, Section of Gynecologic Oncology, Fundación Santa Fe de Bogotá, Bogotá, Colombia
| | - Rene Pareja
- Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Bogotá́, Colombia; Department Gynecologic Oncology, Clínica ASTORGA, Medellín, Colombia
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Liu P, Dai E, Li W, He F, Yang R, Bin X, Lang J, Chen C. Effect of pre-operative radiotherapy on long-term outcomes among women with Stage IB1 to IIB cervical squamous cell carcinoma. Int J Gynaecol Obstet 2021; 152:125-132. [PMID: 33141931 DOI: 10.1002/ijgo.13463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/26/2020] [Accepted: 11/02/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To compare long-term outcomes between pre-operative radiotherapy followed by open surgery and direct open surgery among women with Stage IB1-IIB cervical squamous cell carcinoma. METHODS A multicenter retrospective cohort study among women with Stage IB1-IIB cervical squamous cell carcinoma who underwent open surgery either directly (SD group) or with pre-operative radiotherapy (PR group) in China 2004-2016. Five-year overall survival (OS) and disease-free survival (DFS) between the two groups were compared by Kaplan-Meier methods and multivariate Cox regression. RESULTS Overall, 8385 women with Stage IB1-IIB were included (PR group, n = 447; SD group, n = 7938). Five-year OS and DFS was significantly lower in the PR than in the SD group (OS: 81.7% vs 91.6%, P < 0.001; DFS: 76.3% vs 86.7%, P < 0.001). As compared with direct surgery, pre-operative radiotherapy was an independent risk factor for 5-year OS (adjusted hazard raio [aHR], 1.75; 95% confidence interval [CI], 1.34-2.30) and DFS (aHR, 1.37; 95% CI, 1.09-1.73) by multivariate Cox regression. Sensitivity analyses confirmed the findings. CONCLUSION Among women with Stage IB1-IIB cervical squamous cell carcinoma, outcomes were found to be worse for those undergoing pre-operative radiotherapy followed by open surgery than for those undergoing direct open surgery.
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Affiliation(s)
- Ping Liu
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Encheng Dai
- Department of Obstetrics and Gynecology, People's Hospital of Linyi City, Linyi, China
| | - Weili Li
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Fangjie He
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Rui Yang
- Department of Obstetrics and Gynecology, Shenzhen Hospital of Peking University, Shenzhen, China
| | - Xiaonong Bin
- Department of Epidemiology, College of Public Health, Guangzhou Medical University, Guangzhou, China
| | - Jinghe Lang
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Beijing, China
| | - Chunlin Chen
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Huertas A, Oldrini S, Nesseler JP, Courrech F, Rétif P, Charra-Brunaud C, Peiffert D. FIGO stage IB1 cervical carcinoma: Place and principles of brachytherapy. Cancer Radiother 2017; 21:155-163. [DOI: 10.1016/j.canrad.2016.09.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Revised: 09/21/2016] [Accepted: 09/21/2016] [Indexed: 02/06/2023]
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Ngô C, Alran S, Plancher C, Fourchotte V, Petrow P, Campitelli M, Batwa S, Sastre X, Salmon RJ, de la Rochefordière A. Outcome in early cervical cancer following pre-operative low dose rate brachytherapy: a ten-year follow up of 257 patients treated at a single institution. Gynecol Oncol 2011; 123:248-52. [PMID: 21906789 DOI: 10.1016/j.ygyno.2011.08.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Revised: 08/05/2011] [Accepted: 08/10/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To report the outcome of preoperative low dose rate uterovaginal brachytherapy (LDR-UVBT) followed by radical surgery in the treatment of early cervical carcinoma. METHODS 257 patients treated at Institut Curie from 1985 to 2008 for cervical carcinoma less than 4cm (FIGO stages Ib1, IIA and IIB) were studied. Patients received preoperative LDR-UVBT followed by hysterectomy Piver II type, with pelvic lymph nodes dissection (PLND). Predictive factors for pathological response to brachytherapy were analyzed with logistic regression, as well as survival rates. RESULTS 44% of patients had residual tumor, 4.3% of patients had parametrial invasion and 17.9% of patients had lymph node involvement. Predictive factors for an incomplete pathological response were: initial clinical tumor size 20mm (OR 2.1), pN1 (OR 2.77), glandular carcinoma (OR 2.51) and lymphovascular invasion (OR 4.35). 7.4% and 2.7% of patients had respectively grade 2 and grade 3 post-therapeutic late complications. Median follow up was 122 months [1-282]. Five-year actuarial overall survival and disease free survival were respectively 83% CI [78.3-87.5] and 80.9% CI [76.3-85.7]. In multivariate analysis, factors affecting significantly the overall survival and disease free survival rates were: lymph node involvement (RR 4.53 and 8.96 respectively), parametrial involvement (RR 5.69 and 5.62 respectively), smoking (RR 3.07 and 2.63 respectively). CONCLUSIONS Preoperative LDR-UVBT results in good disease control with a low complications rate. Its accuracy could be improved by a better selection of patients. Lymph nodes and parametrial evaluation remains a challenging issue that should be achieved with imaging and minimal invasive surgery.
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Affiliation(s)
- C Ngô
- Department of Surgical Oncology, Institut Curie, 75005 Paris, France.
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Gruen A, Musik T, Köhler C, Füller J, Wendt T, Stromberger C, Budach V, Schneider A, Marnitz S. Adjuvant chemoradiation after laparoscopically assisted vaginal radical hysterectomy (LARVH) in patients with cervical cancer. Strahlenther Onkol 2011; 187:344-9. [DOI: 10.1007/s00066-011-2197-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Accepted: 01/24/2011] [Indexed: 11/29/2022]
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Hannoun-Levi JM. Traitement du cancer du sein et de l'utérus : impact physiologique et psychologique sur la fonction sexuelle. Cancer Radiother 2005; 9:175-82. [PMID: 16023044 DOI: 10.1016/j.canrad.2004.11.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2004] [Revised: 10/24/2004] [Accepted: 11/10/2004] [Indexed: 11/25/2022]
Abstract
The analysis of the impact of breast and uterus cancer and their treatments on sexual function remains a tricky approach, especially due to some difficulties of communication between patient and medical staff. Some cultural, social, physiological and psychological considerations can change the evolution of sexual function during and after cancer treatment. For breast cancer, mastectomy or conservative approach, as well as radiotherapy and chemotherapy, can induce a modification of body image, femininity, power of seduction and sexuality. For uterus cancer, radio-surgical treatments can induce local (shrinking or vagina dryness,...) or general (early menopause) modifications leading to a decrease of sexual relations. The present analysis of the literature gives a better knowledge of the sexual function troubles according to the type, stage and treatment of the cancer as well as the context in which it appears, especially in regard to personal, family (couple relation before the disease occurrence), social and cultural considerations. A critical point is to introduce, as soon as possible, in the therapeutic program, a global approach including side effects on sexual function and to analyze very carefully the own ability of the patient to manage the difficulties occurring during the treatment.
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Affiliation(s)
- J M Hannoun-Levi
- Département de radiothérapie, centre Antoine-Lacassagne, 33, avenue de Valombrose, 06189 Nice cedex, France.
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Marchal C, Rangeard L, Brunaud C. Impact de l'anémie sur les traitements des cancers du col utérin. Cancer Radiother 2005; 9:87-95. [PMID: 15820436 DOI: 10.1016/j.canrad.2005.01.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2004] [Revised: 12/30/2004] [Accepted: 01/04/2005] [Indexed: 10/25/2022]
Abstract
During the treatments of carcinomas of the cervix, anemia is relatively frequent and its origin is complex combining often hemorrhage, iron deprivation, inflammatory reactions and infection. The frequency of the primary anemia (hemoglobin level<12 g/dl) is correlated with clinical stage and varies from one publication to another, mainly from 25% for stage I, to 33% for stage II and can approach 40% for stage III. Anemia is correlated with patient survival and it appears to be one of the most powerful prognostic factor after clinical stage and tumor size. Anemia is a bad prognostic factor related to stage and tumor size but it has not been proven to be an independent factor. Anemia increases hypoxia of cervix carcinomas, which is an independent prognostic factor for patients N0. Moreover, we know that the oxygenation of these tumors is correlated with hemoglobin levels. The normalization of Hb levels by transfusion could certainly modify the prognosis of patients anemic before treatment, or of those becoming anemic during radiotherapy treatment. For smokers, anemia is certainly more important that we can appreciate from the Hb levels only, by the presence of carboxyhemoglobin. Concomitant chemotherapies with cisplatin compounds are actually standards and they can largely increase the risk of inducing anemia, therefore more than 50% of patients will experiment it during their different treatments. Transfusion is recommended by the SOR (Standards Options and Recommendations of the Fédération nationale des centres de lutte contre le cancer) under 10 g/dl. The use of erythropoietin is a therapeutic option for Hb levels between 10 and 12 g/dl and strongly recommended after a Hb normalization by blood transfusion. For 70% of patients who respond to erythropoietin, a better control of the Hb level is obtained. The impact of this anemia on quality of life and treatments compliance justifies the use of erythropoietin, especially in cancers for which treatments induce a deep fatigue and a very bad tolerance, which could be a limiting factor.
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Affiliation(s)
- C Marchal
- Département de radiothérapie, centre Alexis-Vautrin, avenue de Bourgogne, 54511 Vandoeuvre-lès-Nancy, France.
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