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Pathologic Complete Remission after Preoperative High-Dose-Rate Brachytherapy in Patients with Operable Cervical Cancer: Preliminary Results of a Prospective Randomized Multicenter Study

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Pathology & Oncology Research

Abstract

The role of preoperative intrauterine brachytherapy (BT) in the multidisciplinary treatment of early stage cervical carcinoma (ESCC) is controversial. In 2005, a prospective randomized multicenter study was initiated in Hungary in order to explore the potential advantages of preoperative high-dose-rate (HDR) BT. In this article we evaluate the efficiency of preoperative HDR BT by the rate of pathologic complete remission (pCR) in the first 185 patients enrolled in the study at the National Institute of Oncology and at the Uzsoki Municipal Cancer Center in collaboration with the 1st Department of Gynaecology and Obstetrics of Semmelweis University, Budapest, Hungary. In arm A, patients received 2x8Gy preoperative intracavitary HDR BT, while in arm B no preoperative treatment was given. In both arms patients underwent radical Wertheim (Piver III) hysterectomy. The pCR rate was 25.7% after preoperative HDR BT, while it was only 11.2% with surgery alone (p=0.03), in these cases the tumor was eliminated during the diagnostic excision or conisation. The rate of positive surgical margins was 1.5% after preoperative BT, while it was as high as 11.4% without preoperative RT (p=0.02). There was no significant difference in the local tumor control (LTC), distant metastases free survival (DMFS) and overall survival (OS) between the two arms. According to our preliminary results preoperative intracavitary HDR BT significantly increases the rate of pCR and decreases the rate of positive surgical margins in patients with ESCC. Longer follow-up is required to establish the possible impact of pCR on the ultimate LTC and OS.

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Authors and Affiliations

  1. National Institute of Oncology, Center of Radiotherapy, Budapest, Hungary

    Julia Vízkeleti, Georgina Fröhlich, Szilvia Varga & Csaba Polgár

  2. National Institute of Oncology, Center of Tumor Pathology, Budapest, Hungary

    Ildikó Vereczkey

  3. National Institute of Oncology, Center of Radiology, Budapest, Hungary

    Katalin Horváth

  4. National Institute of Oncology, Center of Gynaecology, Budapest, Hungary

    Tamás Pulay & Imre Pete

  5. Uzsoki Municipal Cancer Center, Budapest, Hungary

    Csaba Nemeskéri & Árpád Mayer

  6. Semmelweis University Faculty of Medicine, Ist Department of Obstetrics and Gynaecology, Budapest, Hungary

    Norbert Sipos

  7. National Institute of Oncology, Budapest, Hungary

    Miklós Kásler

  8. University of Medicine and Pharmacy of Târgu Mureș, Târgu Mureș, Romania

    Julia Vízkeleti

Authors
  1. Julia Vízkeleti
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  2. Ildikó Vereczkey
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  3. Georgina Fröhlich
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  4. Szilvia Varga
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  6. Tamás Pulay
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  7. Imre Pete
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  8. Csaba Nemeskéri
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  9. Árpád Mayer
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  10. Norbert Sipos
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  11. Miklós Kásler
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  12. Csaba Polgár
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Correspondence to Julia Vízkeleti.

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Vízkeleti, J., Vereczkey, I., Fröhlich, G. et al. Pathologic Complete Remission after Preoperative High-Dose-Rate Brachytherapy in Patients with Operable Cervical Cancer: Preliminary Results of a Prospective Randomized Multicenter Study. Pathol. Oncol. Res. 21, 247–256 (2015). https://doi.org/10.1007/s12253-014-9815-5

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  • DOI: https://doi.org/10.1007/s12253-014-9815-5

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