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Clear Cell Adenocarcinoma of the Female Genital Tract: Long-Term Outcome and Fertility Aspects After Brachytherapy Aimed at a Conservative Treatment
  1. Nicolas Magné, MD, PhD*,
  2. Cyrus Chargari, MD*,
  3. Antonin Levy, MD*,
  4. Carlos Rodriguez, MD*,
  5. Véronique De Vos, MD*,
  6. Alain Gerbaulet, MD*,
  7. Pierre Duvillard, MD,
  8. Philippe Morice, MD, PhD and
  9. Christine Haie-Meder, MD*
  1. *Department of Radiotherapy, Brachytherapy Service,
  2. Department of Pathology, Pathological Gynecology Service, and
  3. Department of Surgical Oncology, Surgical Gynecology Service, Institut Gustave Roussy, Villejuif, France.
  1. Address correspondence and reprint requests to Nicolas Magné, MD, PhD, Department of Radiotherapy, Brachytherapy Unit, Institut de Cancérologie de la Loire, 108 bis, avenue Albert Raimond, BP 60008, 42271 St Priest en Jarez cedex, France. E-mail: nicolas.magne{at}icloire.fr.

Abstract

Objectives To assess the outcome and the fertility aspects in the particular population of cervical and/or vaginal clear cell adenocarcinoma (CCA) associated or not to previous in utero diethylstilbestrol exposure.

Methods From January 1970 to December 2003, data from 61 consecutive patients with cervical and/or vaginal histologically proven CCA treated with brachytherapy (BT) aimed at a conservative treatment at the Institut Gustave Roussy as a part of treatment were retrospectively analyzed.

Results The median follow-up was 9.4 years, ranging from 0.3 to 27.4 years. The 5-year specific overall survival rate was 79%. The median time of disease-free survival was 5.8 years. In the subgroup of 42 patients with a cervical CCA, 12 patients tried to be pregnant, 2 patients became pregnant and had miscarriages (P2M2 and P1M1). No pregnancy has been observed in 10 patients exclusively owing to anomalies of the reproductive tract: 6 patients had partial or total diaphragm, 2 patients had an anatomical alteration of the uterus, 1 patient had atrophic endometrium, and 1 patient had primary infertility. In the subgroup of 19 patients with a vaginal CCA, 7 patients tried to be pregnant. All of them had no morphological and/or functional anomalies of the genital tract. Three of 7 patients had delivered healthy babies (P1D1, P2D2, and P3M2D1), and another one had a miscarriage (P1M1). Moreover, all babies were delivered by cesarean section. The pregnancy rate was 10% (6 of 61 patients) with 3 healthy babies.

Conclusion Conservative approach in patients with female genital tract CCA including BT gives good results with good survival rates and an interesting global pregnancy rate.

  • Brachytherapy
  • Clear cell adenocarcinoma
  • Diethylstilbestrol
  • Cervical cancer
  • Vaginal cancer
  • Fertility
  • Adverse effects

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Footnotes

  • The authors declare no conflicts of interest.

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