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Review
Neoadjuvant chemotherapy in early-stage cervical cancer (<2 cm) before conization for fertility preservation: is there any advantage over upfront conization?
  1. Florencia Noll1,2,
  2. Ana Tatiana Palacios Torres3,
  3. Pablo Pecci4,5,
  4. Sergio Martin Lucchini2 and
  5. Fernando Heredia6,7
  1. 1 Department of Gynecologic Oncology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
  2. 2 Department of Gynecology, Section of Gynecologic Oncology, Sanatorio Allende, Cordoba, Argentina
  3. 3 Gynecologic Oncology, Fundacion Universitaria de Ciencias de la Salud - FUCS, Hospital de San José, Bogota, Colombia
  4. 4 Gynecologic Oncology, Centro Oncologico Puerto Madryn, Chubut, Argentina
  5. 5 Gynecologic Oncology, Centro de Diagnóstico Roca, Trelew, Argentina
  6. 6 Gynecologic and Obstetrics Department, Faculty of Medicine, Universidad de Concepción, Concepción, Chile
  7. 7 Minimally Invasive and Robotic Gynecology Unit, Clínica Andes Salud, Concepción, Chile
  1. Correspondence to Dr Florencia Noll, Gynecologic Oncology, Hospital Italiano de Buenos Aires, Buenos Aires C1199, Argentina; florencia.noll{at}hospitalitaliano.org.ar

Abstract

Background Neoadjuvant chemotherapy before fertility-sparing surgery is an accepted option for patients with cervical tumors between 2 cm and 4 cm. There is a paucity of data regarding its role in patients with tumors <2 cm. Our objective was to compare the oncological and obstetrical outcomes between patients who underwent neoadjuvant chemotherapy before cervical conization versus upfront cervical conization in patients with cervical cancer with tumors <2 cm.

Methods We conducted a systematic literature review and searched MEDLINE, EMBASE, and CINAHL (from 1995 to March 2020) using the terms: uterine cervix neoplasms, cervical cancer, fertility-sparing surgery, fertility preservation, conization, cone biopsy, and neoadjuvant chemotherapy. We included manuscripts with information on patients with tumor size <2 cm, lymph node status, follow-up, oncological and obstetrical outcome, and toxicity related to neoadjuvant chemotherapy. We excluded review articles or articles with duplicated patient information.

Results We identified 12 articles, including 579 patients. For final analysis, 261 patients met inclusion criteria. The most common histology was non-squamous cell carcinoma (62%). Median follow-up time was 63.5 (range 7–122) months for the neoadjuvant chemotherapy group and 48 (range 12–184) months for the upfront cervical conization group. There was no difference in either overall survival (neoadjuvant chemotherapy group 100% vs upfront cervical conization 99.7%, p=0.79) or disease-free survival (neoadjuvant chemotherapy 100% vs upfront cervical conization 98.9%, p=0.59) between the groups. Fertility preservation rate was 81.4% versus 99.1% (p<0.001) favoring upfront cervical conization. No statistically significant differences were seen in live birth rate or pregnancy loss. Also, we found that all neoadjuvant chemotherapy patients reported chemotherapy-related toxicity (30.7% grade 3 and 69.2% grade 1–2).

Conclusions There was no difference in disease-free survival or overall survival between patients who underwent neoadjuvant chemotherapy followed by conization and upfront cervical conization. Patients who underwent upfront cervical conization had a higher fertility preservation rate.

  • cervical cancer
  • cervix uteri

https://doi.org/10.1136/ijgc-2020-001751

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    • Contributors All the authors contributed to the writing, drafting, and critical revision of the original manuscript. All the authors approved the final version for publication, and accept responsibility for the content of this review article.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.