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Fertility-Sparing Management for Bulky Cervical Cancer Using Neoadjuvant Transuterine Arterial Chemotherapy Followed by Vaginal Trachelectomy
  1. Hiroshi Tsubamoto, MD, PhD*,
  2. Riichiro Kanazawa, MD, PhD*,
  3. Kayo Inoue, MD*,
  4. Yoshihiro Ito, MD*,
  5. Shinji Komori, MD, PhD*,
  6. Hiroaki Maeda, MD, PhD and
  7. Shozo Hirota, MD, PhD
  1. *Departments of Obstetrics and Gynecology, and
  2. Radiology, Hyogo College of Medicine, Hyogo, Japan.
  1. Address correspondence and reprint requests to Hiroshi Tsubamoto, MD, PhD, Department of Obstetrics and Gynecology, Hyogo College of Medicine, Mukogawa 1-1, Nishinomiya, Hyogo 663-8501, Japan. E-mail: tsuba{at}hyo-med.ac.jp.

Abstract

Background Fertility-sparing management for bulky cervical cancer remains under investigation. We investigated the safety of neoadjuvant transuterine arterial chemotherapy (TUAC) followed by a simple vaginal trachelectomy for patients with tumors larger than 3 cm in diameter who desired uterine preservation.

Methods First, to assess the safety and efficacy of TUAC, survival and pathological complete response data from 39 patients with a diagnosis of stage IB2 to stage IIB cervical cancer who participated in 2 consecutive trials during 1997–2006 were analyzed. The neoadjuvant chemotherapy regimens were a combination of TUAC using cisplatin with intravenous nedaplatin or irinotecan. Second, to assess the safety of fertility-sparing management with TUAC, medical records of patients matching the following criteria were reviewed during the same period: (1) International Federation of Gynecology and Obstetrics stages IB1 to IIA; (2) maximum diameter of tumor, 3 cm or more; (3) squamous cell carcinoma; (4) no radiological findings of lymph node metastasis; and (5) patient’s strong desire for preservation of the uterus and to undergo TUAC.

Results The overall 5-year survival rate of the 39 enrolled patients was 81.0% (95% confidence interval, 64.8%–93.7%). No malignant cells were found in pathologically examined surgical specimens from 14 patients (35.9%), all of whom were alive without recurrence for more than 7 years after treatment. Based on medical records, 7 patients were eligible according to the fertility-sparing criteria, 1 patient with International Federation of Gynecology and Obstetrics stage IB1 cancer, 5 patients with stage IB2, and 1 patient with stage IIA. One patient with stage IB1 cancer and 2 patients with stage IB2 cancer underwent simple vaginal trachelectomy, resection of paracervical tissues, and abdominal lymphadenectomy. Their disease-free intervals were 86, 120, and 65 months, respectively. All 3 patients had regular menses after surgery but no pregnancies, for personal reasons unrelated to fertility.

Conclusions Powerful neoadjuvant chemotherapy regimens resulted in a pathological complete response. Long-term disease-free interval was achieved after fertility-sparing management for bulky cervical cancer in 3 cases.

  • Fertility-sparing
  • Neoadjuvant chemotherapy
  • Transuterine arterial chemotherapy
  • Trachelectomy

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Footnotes

  • The authors declare that there are no conflicts of interest.

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