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Neoadjuvant chemotherapy prior to fertility-sparing surgery in cervical tumors larger than 2 cm: a systematic review on fertility and oncologic outcomes
  1. Javier Burbano1,
  2. Fernando Heredia2,
  3. Daniel Sanabria3,4,
  4. Edison Gilberto Ardila3,
  5. David Viveros-Carreño4 and
  6. Juliana Rodriguez4,5
  1. 1 Department of Gynecologic Oncology, Fundacion Clinica Valle del Lili, Cali, Colombia
  2. 2 Department of Gynecology and Obstetrics, School of Medicine, Universidad de Concepción, Concepción, Chile
  3. 3 Department of Gynecologic Oncology, Clínica Los Nogales, Bogota, Colombia
  4. 4 Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Bogota, Colombia
  5. 5 Department of Gynecology and Obstetrics, Section of Gynecologic Oncology, Fundación Santa Fe de Bogota, Bogota, Colombia
  1. Correspondence to Dr Juliana Rodriguez, Instituto Nacional de Cancerologia, Bogota, Colombia; julianalrc1106{at}gmail.com

Abstract

Background Management of cervical cancer tumors >2 cm has been a subject of controversy, with management often considered as either up-front radical trachelectomy or neoadjuvant chemotherapy before fertility-sparing surgery.

Methods A systematic literature review was conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) checklist. This study was registered in the International Prospective Register of Systematic Reviews (PROSPERO). We searched Medline through PubMed, EMBASE, Cochrane Central Register of Controlled Trials, SCOPUS, and OVID between January 1985 and December 2020. Eligibility criteria for selecting studies were English language, randomized controlled trials, and observational studies including information on fertility and oncologic outcomes. All titles were managed in EndNote X7. Risk of bias was evaluated using the Joanna Briggs Institute (JBI) critical appraisal checklist for observational studies.

Results Twenty-three studies with 205 patients who received neoadjuvant chemotherapy were included. The majority of patients (92.2%, n=189) had stage IB FIGO 2009 cervical cancer. The preferred regimen used was cisplatin in combination with paclitaxel or ifosfamide (80%, n=164). One hundred and eighty patients (87.8%) underwent fertility-sparing surgery; radical vaginal trachelectomy, abdominal trachelectomy, conization, and simple trachelectomy were performed in 62 (34.4%), 49 (27.2%), 34 (18.9%), and 26 (14.4%) women, respectively. In nine patients (5%) the type of procedure was not specified. The follow-up time reported in all studies ranged between 6 and 69 months. In 112 women who sought a pregnancy after surgery, 84.8% (n=95) achieved a gestation.The global recurrence and death rates were 12.8% and 2.8%, respectively.

Conclusion Neoadjuvant chemotherapy followed by fertility-sparing surgery is a promising strategy that might allow fertility preservation in highly selected patients with cervical cancer with tumors >2 cm while providing acceptable oncologic outcomes. Results of prospective studies are required to validate its oncological safety.

Systematic review registration number PROSPERO CRD42020203789.

  • cervix uteri
  • cervical cancer

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Footnotes

  • Twitter @danielsanabrias

  • Contributors JB, JR: study design; JR, DV-C: literature search; JB, DS: review of the articles. JB, JR, EGA: data extraction of the included articles;

    JB, FH, DS, EGA, DV-C, JR: writing of the article. All authors approved the final version of the manuscript.

  • 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.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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