# A comparative analysis of survival outcomes and adverse effects between preoperative brachytherapy with radical surgery and concurrent chemoradiotherapy in patients with locally advanced cervical cancer

## TL;DR

This study compares two treatments for advanced cervical cancer and finds that preoperative brachytherapy with surgery improves survival and reduces side effects compared to chemoradiotherapy.

## Contribution

The study introduces preoperative brachytherapy combined with surgery as a potentially superior treatment for locally advanced cervical cancer.

## Key findings

- Preoperative brachytherapy combined with surgery improved 5-year progression-free survival compared to chemoradiotherapy.
- The treatment modality was an independent prognostic factor for progression-free survival.
- The study group experienced fewer severe adverse effects like radiation enteritis and anemia.

## Abstract

To compare the long-term efficacy and adverse effects of preoperative brachytherapy combined with radical surgery versus concurrent chemoradiotherapy (CCRT) in patients with locally advanced cervical cancer (LACC).

This retrospective study analyzed 161 patients with LACC treated at the Affiliated Hospital of North Sichuan Medical College between January 2015 and December 2020. Of these, 76 patients underwent preoperative brachytherapy combined with radical surgery (study group), while 85 received CCRT (control group). After propensity score matching (PSM) to minimize confounding, 124 patients (62 per group) were included in the analysis. Survival outcomes and prognostic factors were evaluated using Kaplan-Meier survival analysis and Cox regression models. Adverse effects of treatment were compared between the groups.

After PSM, the 5-year progression-free survival (PFS) rate in the study group was significantly higher than that in the control group (81.2% vs. 62.7%, P<0.05). There was no significant between-group difference regarding the 5-year overall survival (OS) rate (81.4% vs. 74.9%, P=0.41). Multivariate analysis identified treatment modality (preoperative brachytherapy combined with radical surgery vs. CCRT) as an independent prognostic factor for PFS (HR: 0.458, 95% CI 0.221–0.945, P=0.035). The study group had significantly lower rates of grade 2 acute radiation enteritis, grade 3-4 leukopenia, and anemia compared to the control group (P<0.05), with no significant differences observed in other adverse effects (P>0.05).

Preoperative brachytherapy combined with radical surgery may help improve the PFS of patients with LACC, with fewer adverse effects, making it a potentially viable treatment option for these patients.