Clinical efficacy of preoperative vaginal intracavitary irradiation for Stage Ib2 and IIa cervical cancer.

OBJECTIVE: The purpose of this study was to evaluate the clinical efficacy of preoperative vaginal intracavitary irradiation for Stage Ib2 and IIa cervical cancer.

MATERIALS AND METHODS: From June 2008 to June 2014, data from 78 Stage Ib2 and IIa cervical cancer patients (age ≤75 years) with a diameter of local lesions >4 cm were collected in our hospital. Before treatment, all cases were confirmed by biopsy. The patients' general state was good, Karnofsky Performance Score ≥90, heart and lung functioning was normal, and patients were able to tolerate the surgery. The 78 patients were randomly divided into two groups: neoadjuvant radiotherapy group (NRG) (n = 38) and radical surgery group (n = 40). Patients in NRG received 2000~3000 cGy192 Ir irradiation of preoperatively intracavitary brachytherapy (radioactive source at 1 cm distance). After a rest of 10-14 days, radical hysterectomy with pelvic lymphadenectomy was performed. Surgery alone group (SAG) (n = 40) underwent radical surgery directly. The treatment outcomes between these two groups were compared, and the effect of preoperative intracavitary brachytherapy and presence of postoperative complications were evaluated.

RESULTS: The total clinical efficacy for intracavitary brachytherapy was 94.7% (36/38) with complete response 13 (34.2%), partial response 23 (60.5%), and stable disease 2 (5.3%). Moreover, no patients developed progression disease; for SAG patients, 32 cases successfully finished the extensive hysterectomy and pelvic lymphadenectomy. Operation time <240 min was found in 19 patients. Moreover, the positive complication for lymphatic cyst and urinary retention was 20.0% and 15.0%, respectively. For NAG group, 36 patients successfully finished the extensive hysterectomy and pelvic lymphadenectomy. Operation time <240 min was found in 22 patients. Moreover, the positive complication for lymphatic cyst and urinary retention was 15.8% and 13.2%, respectively. The median follow-up time for NRG and SAG was 28 and 30 months, respectively. Three cases lost to follow-up in the SAG with the follow-up rate of 92.5% (37/40). In the NRG group, 3 cases lost to follow-up with the follow-up rate of 92.1% (35/38). The locoregional control rate for 1, 3, and 5 years was 80.0%, 61.3%, and 52.6%, respectively, for SAG group and 89.5%, 82.9%, and 76.9%, respectively, for NRG group with significant statistical difference for 3 and 5 years.

CONCLUSION: Preoperative intracavitary brachytherapy is an effective procedure for the treatment for Stage Ib2 and IIa cervical cancer and can significantly improve the locoregional control rate.