Radical Hysterectomy in Patients with Locally Advanced Cervical Cancer: Would it be an Option in Centers Lacking Brachytherapy Technique?

Background: Locally advanced cervical cancer patients’ treatment depends 
optimally on multimodality options, which could be very challenging, due to the 
lack of intracavitary brachytherapy in many centers. Although non-surgical 
option is very appealing, yet it is not always available. An alternative non-
standard approach is neo-adjuvant concurrent chemo-radiotherapy (CCRT) 
followed by radical hysterectomy. 
Patients and methods: A retrospective study involving patients with 
pathologically proven cervical cancer, FIGO stages IB2 till IVA who presented 
to Clinical Oncology Department, Cairo University, during the period from 
January 2015 till December 2020. Data was retrieved from our medical records. 
Patients were divided into 2 arms; (Arm A: 40 patients) included patients treated 
with neoadjuvant CCRT, followed by radical hysterectomy and (Arm B: 41 
patients) included those who received the standard of care; CCRT followed by 
intracavitary brachytherapy.
Results: The loco-regional control rate was 75% in arm A, compared to 
85.3%in arm B, with non-significant P-value (p=0.24). However, relapse rates 
were significantly higher in arm A (47.5%) than in arm B (14.5%) (p= 0.007). 
Moreover, distant metastases were higher in arm A (22.5%) than in arm B 
(4.9%) with a statistically significant P-value = 0.025.
There was no significant difference between the two groups as regards survival 
data (PFS and OS). However, concerning the toxicity profile, both arms 
experienced comparable toxicity profile pattern after CCRT; Yet dysuria was 
the most common early and late toxicity after intracavitary brachytherapy (arm 
B) presenting 39% and 29.7% respectively.
Conclusion: Offering surgery as an alternative approach to intracavitary 
brachytherapy is an acceptable option, in centers lacking brachytherapy 
technique, without compromising survival outcome.