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Master Thesis

Quelle est la place de la curiethérapie préopératoire suivie d'une hystérectomie par voie mini invasive dans la prise en charge des cancers du col de stade précoce ?

Abstract : OBJECTIVES: The aim of this study is to report the oncological and surgical outcomes of an alternative therapeutic strategy consisting of a preoperative brachytherapy followed by Type A laparoscopic or abdominal hysterectomy as an alternative to upfront surgery. MATERIAL / METHODS: This is a retrospective study conducted at Paoli Calmettes Institute, comprehensive cancer center (Marseille, France) between 2001 and 2012, concerning patients managed for early stage cervical cancer (tumor size < 4 cm, FIGO stage IA1, IA2, IB1 et IB2 - FIGO 2018) by a radiosurgical approach. A pre operative low dose rate brachytherapy was performed in pN0 patients (Surgical and radiological) , followed 6-8 weeks later by a type A hysterectomy by laparoscopic or open surgical approach. Patients with pelvic lymph node metastases or adjuvant treatment were excluded. The primary endpoint was the disease free survival (DFS) and the secondary endpoint was the surgical and brachytherapy morbidities. RESULTS: A total of 138 patients were included. Histological analysis showed a complete response in 68 patients (49,3 %) and a residual tumor < 1 cm in 36 patients (26 %). With a median follow up of 132 months (60 - 204 months), DFS was 93,5% with 9 recurrences, 6 distant (with peritoneal carcinosis, lung or liver metastasis), 2 pelvic lymph node recurrences and 1 local recurrence (left pyramidalis muscle). In univariate analysis, a delay between the end of brachytherapy and surgery more than 52 days is associated with a significative poorer DFS (p = 0,004 , OR = 8,5, IC95 {1,5 ; 48,7}), and a pathological complete response is associated with a better DFS ( p = 0,03 OR = 6,1 IC95 {1,8 ; 55,3 }). We have reported an overall late complication rate for brachytherapy of 17,3% (n= 24) (Chassagne glossary) and an overall rate of surgical urinary injuries of 6,5% (n = 9 ), with only 2 patients (1,5 %) with grade 3 complications (Clavien and Dindo classification). CONCLUSION: With a median follow up of 132 months, a radio surgical management of early stage cervical cancers (less than IB3) including brachytherapy and type A laparoscopic hysterectomy seems to offer a reasonable rate of recurrences compared to LACC trial’s results. This strategy may be an alternative to upfront radical hysterectomy in selected patients to maintain a minimal invasive approach.
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Clémence Beyer. Quelle est la place de la curiethérapie préopératoire suivie d'une hystérectomie par voie mini invasive dans la prise en charge des cancers du col de stade précoce ?. Médecine humaine et pathologie. 2020. ⟨dumas-02507399⟩

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