Pre-operative high-dose-rate brachytherapy in early-stage cervical cancer: long-term single-center results

Sylwia Kellas-Ślęczka; Piotr Wojcieszek; Marta Szlag; Magdalena Stankiewicz; Agnieszka Cholewka; Maciej Ślęczka; Agnieszka Badora-Rybicka; Piotr Lelek; Agnieszka Pruefer; Tomasz Krzysztofiak; Zofia Kołosza; Marek Fijałkowski

doi:10.5114/jcb.2022.112697

eISSN: 2081-2841
ISSN: 1689-832X

Journal of Contemporary Brachytherapy

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Original paper

Pre-operative high-dose-rate brachytherapy in early-stage cervical cancer: long-term single-center results

Sylwia Kellas-Ślęczka

¹

,

Piotr Wojcieszek

¹

,

Marta Szlag

²

,

Magdalena Stankiewicz

¹

,

Agnieszka Cholewka

²

,

Maciej Ślęczka

³

,

Agnieszka Badora-Rybicka

⁴

,

Piotr Lelek

¹

,

Agnieszka Pruefer

²

,

Tomasz Krzysztofiak

¹

,

Zofia Kołosza

⁵

,

Marek Fijałkowski

¹

Brachytherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, Poland
Radiotherapy Planning Department, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, Poland
Institute of Mathematics, University of Silesia in Katowice, Katowice, Poland
Breast Cancer Unit, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, Poland
Department of Biostatistics and Bioinformatics, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, Poland

J Contemp Brachytherapy 2022; 14, 1: 43–51

DOI: https://doi.org/10.5114/jcb.2022.112697

Online publish date: 2022/01/19

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AMA

Kellas-Ślęczka S, Wojcieszek P, Szlag M, et al. Pre-operative high-dose-rate brachytherapy in early-stage cervical cancer: long-term single-center results. Journal of Contemporary Brachytherapy. 2022;14(1):43-51. doi:10.5114/jcb.2022.112697.

APA

Kellas-Ślęczka, S., Wojcieszek, P., Szlag, M., Stankiewicz, M., Cholewka, A.,  & Ślęczka, M. et al. (2022). Pre-operative high-dose-rate brachytherapy in early-stage cervical cancer: long-term single-center results. Journal of Contemporary Brachytherapy, 14(1), 43-51. https://doi.org/10.5114/jcb.2022.112697

Chicago

Kellas-Ślęczka, Sylwia, Piotr Wojcieszek, Marta Szlag, Magdalena Stankiewicz, Agnieszka Cholewka, Maciej Ślęczka,  and Agnieszka Badora-Rybicka et al. 2022. "Pre-operative high-dose-rate brachytherapy in early-stage cervical cancer: long-term single-center results". Journal of Contemporary Brachytherapy 14 (1): 43-51. doi:10.5114/jcb.2022.112697.

Harvard

Kellas-Ślęczka, S., Wojcieszek, P., Szlag, M., Stankiewicz, M., Cholewka, A., Ślęczka, M., Badora-Rybicka, A., Lelek, P., Pruefer, A., Krzysztofiak, T., Kołosza, Z.,  and Fijałkowski, M. (2022). Pre-operative high-dose-rate brachytherapy in early-stage cervical cancer: long-term single-center results. Journal of Contemporary Brachytherapy, 14(1), pp.43-51. https://doi.org/10.5114/jcb.2022.112697

MLA

Kellas-Ślęczka, Sylwia et al. "Pre-operative high-dose-rate brachytherapy in early-stage cervical cancer: long-term single-center results." Journal of Contemporary Brachytherapy, vol. 14, no. 1, 2022, pp. 43-51. doi:10.5114/jcb.2022.112697.

Vancouver

Kellas-Ślęczka S, Wojcieszek P, Szlag M, Stankiewicz M, Cholewka A, Ślęczka M et al. Pre-operative high-dose-rate brachytherapy in early-stage cervical cancer: long-term single-center results. Journal of Contemporary Brachytherapy. 2022;14(1):43-51. doi:10.5114/jcb.2022.112697.

Purpose
The aim of the study was to report the outcomes of pre-operative high-dose-rate brachytherapy (pHDR-BT), followed by hysterectomy in patients with early cervical cancer.

Material and methods
From January, 1998 to December, 2003, 113 women with IB1, IB2, and IIA1 cervical cancer (according to International Federation of Gynecology and Obstetrics [FIGO] 2018) were treated with pHDR-BT, and 6 to 8 weeks later followed by radical hysterectomy. Patients found to have positive lymph nodes, residual cervical cancer, involved parametria, or lymphovascular space invasion (LVSI) received post-operative adjuvant therapy.

Results
Post-operatively, 81.4% of patients had a complete response to pHDR-BT in the cervix, and 18.6% had residual cervical cancer. Failures occurred in 11/113 (9.7%) patients (all were stage IIA1), with pelvic recurrences in 5/113 (4.4%) and distant metastasis (DM) in 6/113 (5.3%). The 5- and 10-year disease-free survival (DFS) rates were 100% for IB1 and IB2, and 86.4% and 81.3% for IIA1, respectively. Lymph node involvement and/or residual cervical cancer correlated with worse DFS. Two vesicovaginal fistulas were observed (one in a patient treated only with pHDR-BT and one in a woman, who underwent adjuvant external-beam radiotherapy [EBRT]). Two rectovaginal fistulas and one case of proctitis were observed in patients treated with adjuvant EBRT.

Conclusions
pHDR-BT in early cervical cancer is well-tolerated and effective in sterilizing tumor cells in the cervix. The growing number of publications in this area may help define an optimal therapeutic scheme, but randomized trials are required to determine the best candidates for this treatment modality. In our opinion, cervical cancer patients with FIGO stage IIA1 are not good candidates for pHDR-BT, and could be given this treatment only after rigorous selection, including assessment with state-of-the-art imaging, due to higher probability of treatment failure.

keywords:

Pre-operative high-dose-rate brachytherapy in early-stage cervical cancer: long-term single-center results

Sylwia Kellas-Ślęczka 1 , Piotr Wojcieszek 1 , Marta Szlag 2 , Magdalena Stankiewicz 1 , Agnieszka Cholewka 2 , Maciej Ślęczka 3 , Agnieszka Badora-Rybicka 4 , Piotr Lelek 1 , Agnieszka Pruefer 2 , Tomasz Krzysztofiak 1 , Zofia Kołosza 5 , Marek Fijałkowski 1

pre-operative, brachytherapy, HDR, cervical cancer