Efficacy of preoperative brachytherapy for controlling vaginal bleeding in early-stage cervical cancer: a retrospective study

BACKGROUND: In our clinical study, 11% of the patients with early-stage cervical cancers had different degrees of vaginal bleeding, which required a preoperative intervention. We set to assess the efficacy and safety of preoperative high-dose rate vaginal ovoid brachytherapy (HDR-VOBT) for the treatment of vaginal bleeding in women with early cervical cancer. METHODS: We retrospectively identified and reviewed patients with vaginal bleeding and early-stage cervical carcinoma, treated between January 2011 and December 2014 (median follow-up of 69 months). Of the 116 patients, 59 received preoperative HDR-VOBT (a dose of 8 Gy at 0.5 cm from the tumor surface), and 57 received traditional vaginal packing with gauze alone, followed by radical hysterectomy and lymphadenectomy. Analysis of the clinical parameters was performed using the chi-square test. The outcome measures were the 3- and 5-year survival and the complication rate. RESULTS: From the 116 patients, 25 had stage IB1, 49 had stage IB2, and 42 had stage IIA1 cervical cancer. No differences were observed regarding the 5-year overall survival (OS) (91.5% vs. 91.2%) and disease-free survival (DFS) (76.3% vs. 86%) between the preoperative HDR-VOBT group and the vaginal packing with gauze group. The mean volume of blood loss due to vaginal bleeding after treatment was 83.4 (range: 30–150) mL: 56.8 (range: 30–80) mL in the preoperative HDR-VOBT group and 111.1 (range: 80–150) mL in the gauze packing group (P<0.001). The mean time to achieve hemostasis was 3.5 h in the preoperative HDR-VOBT group and 8.1 h in the vaginal packing with gauze group (P<0.001). There was no significant difference in postoperative risk factors, complications, and survival between the two groups. CONCLUSIONS: Preoperative HDR-VOBT with a dose of 8 Gy at 0.5 cm from the surface of the tumor has a better hemostatic effect than vaginal packing with gauze, with no additional complications and no need for adjuvant treatment after the operation.