Preoperative brachytherapy of early-stage cervical cancer: A multicenter study by the SFRO brachytherapy group

To report the results of a multicenter cohort of preoperative brachytherapy (PBT) for treatment of early-stage cervical cancer (ESCC). A retrospective analysis was conducted among five French comprehensive cancer centers on behalf of the SFRO Brachytherapy Group to examine the outcome of patients with ESCC who received PBT between 2001 and 2019 because of adverse prognostic factors (tumor size >2 cm, presence of lymphovascular invasion, adenocarcinoma).Brachytherapy was followed 4–8 weeks later by surgery. Local relapse free, distant metastasis-free survival, disease-free, and overall survival and adverse effects were examined. Uni- and multivariate analyses were conducted looking for oncological prognostic factors. A total of 451 patients were identified, with a mean tumor size of 24.7 mm. Adenocarcinoma accounted for 43.5% of cases, and lympho-vascular space invasion (LVSI) was present in 15.7%. A complete histological response was observed in 69.6%. With a mean follow-up of 75.4 months, DFS, LRFS, and OS rates at five years were 88% [95% CI (84–91), 98% [95% CI (96–99), and 92% [95% CI (87–95)], respectively. At the last follow-up, 8.2% of patients had died, including 31 (6.8%) from cervical cancer. Severe side effects range from 1.1% to 2%. At multivariate analysis, adenocarcinoma histological type, tumor size ≥2 cm, and the presence of residual tumors were prognosticators for DFS and DMFS. PBT shows excellent oncological outcomes in this cohort of patients with adverse histoprognostic factors. Favorable survival rates and low complications rates were observed, supporting this strategy in the management of ESCC. •Local recurrence-free survival, distant metastasis-free survival, and five-year overall survival: 88%, 98%, 92%.•Preoperative brachytherapy lowered adjuvant radiotherapy rates to 8.6% in early-stage cervical cancer.•70% of patients showed complete response post-brachytherapy, improving outcomes and reducing recurrence.•Serious complications were low, with only 1.1%–2% of patients experiencing severe side effects.•Significant prognostic factors: adenocarcinoma type, tumor size ≥2 cm, and presence of residual tumors.