Efficacy of preoperative intracavitary brachytherapy and surgery in patients with stage IB2 and IIA bulky cervical cancer

Objective: To analyze the outcomes of preoperative intracavitary brachytherapy plus surgery in patients with stage IB2 and IIA bulky cervical cancer. Methods: From January 2001 to January 2007, 77 patients with stage IB2 and IIA bulky cervical cancer were included. The diameter of primary tumor was greater than 4 cm. Preoperative intracavitary brachytherapy with the total dose of 20-30 Gy (0.5 cm below the vaginal mucosa) was delivered by 2-3 fractions, one fraction per week. After an interval of 10 -14 days, the efficacies of radiotherapy were evaluated and radical hysterectomy with pelvic lymphade- nectomy was periormed. Then the treatment complications, clinicopathological characteristics, survival and recurrence were analyzed. Results: The tumor shrinkage was observed in all the patients after intracavitary brachytherapy. The CR, PR and SD were 5% (4/77), 36% (28/77) and 58% (45/77), respectively. Radical hysterectomy was successfully performed in all patients. The complications of the combined therapy were mild and only 5 patients had grade II or less hematological or gastrointestinal toxicities. The 5-year overall survival rate and pelvic recurrence rate were 83% and 12%, respectively. Conclusions: Preoperative intracavitary brachytherapy of 20 -30 Gy plus surgery is effective in the treatment of stage IB2 and IIA bulky cervical cancer without increasing the treatment complications. (authors)