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Conization and lymph node evaluation as a fertility-sparing treatment for early stage cervical cancer
  1. Fabio Martinelli1,
  2. Antonino Ditto1,
  3. Francesca Filippi2,
  4. Daniele Vinti3,
  5. Giorgio Bogani1,
  6. Umberto Leone Roberti Maggiore1,
  7. Mariateresa Evangelista1,
  8. Mauro Signorelli1,
  9. Valentina Chiappa1,
  10. Salvatore Lopez1,
  11. Edgardo Somigliana2,4 and
  12. Francesco Raspagliesi1
  1. 1 Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
  2. 2 Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Lombardia, Italy
  3. 3 Obstetrics and Gynecology, ASST Rhodense, Garbagnate Milanese, Italy
  4. 4 Università degli Studi di Milano, Milan, Italy
  1. Correspondence to Dr Fabio Martinelli, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Fabio.Martinelli{at}istitutotumori.mi.it

Abstract

Introduction To evaluate oncological and obstetrical outcomes of early stage cervical cancer patients who underwent conservative management to retain childbearing potential.

Methods Data of women (aged <40 years) who underwent fertility sparing treatment for International Federation of Gynecology and Obstetrics (FIGO) stage IA1 with lymphovascular invasion (LVSI) and IB1 cervical cancer were prospectively collected. All patients underwent cervical conization/s and laparoscopic nodal evaluation (pelvic lymphadenectomy/sentinel node mapping). Oncological and obstetrical outcomes were assessed.

Results Overall, 39 patients met inclusion criteria; 36 (92.3%) women were nulliparous. There were: 3 (7.7%) IA1-LVSI+; 11 (28.2%) IA2; and 25 (64.1%) IB1 cervical cancers, according to 2018 FIGO stage classification. Histological types were 22 (56.4%) squamous carcinoma and 17 (43.6%) adenocarcinoma. Pelvic lymphadenectomy was performed in 29 (74.4%) patients, while 10 (25.6%) patients had only sentinel node mapping. In 4 (10.3%) patients conservative treatment was discontinued due to nodal involvement and 2 (5.1%) patients requested definitive treatment (hysterectomy) after a negative lymph node evaluation. Among 33 (84.6%) patients who retained their childbearing potential, 17 (51.5%) had a second conization. 2 (6.1%) patients relapsed and underwent definitive treatment. After a median follow-up of 51 months (range 1–184) no deaths were reported. 22 (70.9%) patients attempted to conceive. There were 13 natural pregnancies among 12 (54.5%) women who got pregnant. Live birth rate was 76.9%: 9 (69.2%) term and 1 (7.7%) preterm (at 32 weeks) deliveries. 2 (15.4%) miscarriages (first and second trimester) and 1 (7.7%) termination of pregnancy for medical reasons were recorded.

Conclusion Conization plus laparoscopic nodal evaluation may be a safe and feasible conservative option in the setting of fertility-sparing treatment for early-stage cervical cancer patients.

  • cervical cancer
  • surgical procedures
  • operative
  • gynecology
  • SLN and lympadenectomy

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Footnotes

  • Twitter @DrFMartinelli

  • Contributors Conception or design of the work (FM, AD, FF, FR). Data collection (FM, FF, DV, GB, ULRM, ME, MS, VC). Data analysis and interpretation (FM, FF, DV, AD). Drafting the article (FM, FF). Critical revision of the article (ES, FR). Final approval of the version to be published (FM, ES, FR).

  • 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 ES has received honoraria from Theramex, Merck-Serono and HRA. He also handles grants of research from Theramex, Merck-Serono and Ferring.

  • Patient consent for publication Not required.

  • Ethics approval Ethical Committee of Fondazione IRCCS Istituto Nazionale Tumori of Milan, protocol INT 68/12.

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

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. Data are available upon reasonable request fabio.martinelli@istitutotumori.mi.it.

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