The treatment of early-stage cervical cancer (CC) is primarily based on surgery. Adjuvant (chemo)radiotherapy can be necessary in presence of risk factors for relapse (tumor size, deep stromal invasion, lymphovascular space invasion (LVSI), positive margins, parametrial or lymph node involvement), increasing the risk of treatment toxicity. Preoperative brachytherapy can reduce tumor extension before surgery, potentially limiting the need for adjuvant radiotherapy. This study reports long-term clinical outcomes on efficacy and toxicity of preoperative pulse-dose-rate (PDR) brachytherapy in early-stage CC. All patients treated at Institut Curie between 2007 and 2022 for early-stage CC by preoperative brachytherapy were included. A PDR technique was used. Patients underwent hysterectomy associated with nodal staging following brachytherapy. 73 patients were included. The median time from brachytherapy to surgery was 45 days [range: 25–78 days]. With a median follow-up of 51 months [range: 4–185], we reported 3 local (4 %), 1 locoregional (1 %) and 8 metastatic (11 %) relapses. At 10 years, OS was 84.1 % [95 % CI: 70.0–100], DFS 84.3 % [95 % CI:74.6–95.3] and LRFS 92.8 % [95 % CI:84.8–100]. Persistence of a tumor residue, observed in 32 patients (44 %), was a significant risk factor for metastatic relapse (p = 0.02) and was associated with the largest tumor size before brachytherapy (p = 0.04). Five patients (7 %) experienced grade 3 toxicity. One patient (1 %) developed grade 4 toxicity. Ten patients (14 %) received adjuvant radiotherapy, increasing the risk of lymphedema (HR 1.31, 95 % CI [1.11–1.54]; p = 0.002). PDR preoperative brachytherapy for early-stage cervical cancer provides high long-term tumor control rates with low toxicity.

中文翻译：

---

早期宫颈癌术前近距离放射治疗的长期临床结果

早期宫颈癌（CC）的治疗主要基于手术。如果存在复发危险因素（肿瘤大小、深部间质侵犯、淋巴管间隙侵犯 (LVSI)、切缘阳性、宫旁或淋巴结受累），则可能需要辅助（化疗）放疗，从而增加治疗毒性风险。术前近距离放射治疗可以减少手术前肿瘤的扩展，从而可能限制辅助放疗的需要。本研究报告了早期 CC 术前脉冲剂量率 (PDR) 近距离放射治疗的疗效和毒性的长期临床结果。 2007 年至 2022 年间在居里研究所接受术前近距离放射治疗的所有早期 CC 患者均纳入其中。使用了PDR技术。患者在近距离放射治疗后接受了与淋巴结分期相关的子宫切除术。包括 73 名患者。从近距离放射治疗到手术的中位时间为 45 天 [范围：25-78 天]。中位随访时间为 51 个月 [范围：4-185]，我们报告了 3 例局部复发 (4%)、1 例局部复发 (1%) 和 8 例转移性复发 (11%)。 10 年时，OS 为 84.1% [95% CI: 70.0–100]，DFS 为 84.3% [95% CI:74.6–95.3]，LRFS 为 92.8% [95% CI:84.8–100]。在 32 名患者 (44%) 中观察到肿瘤残留的持续存在是转移性复发的重要危险因素 (p = 0.02)，并且与近距离放射治疗前最大肿瘤尺寸相关 (p = 0.04)。 5 名患者 (7%) 经历了 3 级毒性。一名患者 (1%) 出现 4 级毒性。 10 名患者 (14%) 接受了辅助放疗，增加了淋巴水肿的风险（HR 1.31，95% CI [1.11–1.54]；p = 0.002）。 PDR 术前近距离放射治疗早期宫颈癌可提供较高的长期肿瘤控制率和较低的毒性。