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  • Oncological and obstetrical outcomes after neo-adjuvant chemotherapy followed by fertility-sparing surgery in patients with cervical cancer ≥2 cm

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Original research
Oncological and obstetrical outcomes after neo-adjuvant chemotherapy followed by fertility-sparing surgery in patients with cervical cancer ≥2 cm
  1. Gabriel J. Rendón1,
  2. Aldo Lopez Blanco2,
  3. Alejandro Aragona3,
  4. José Martín Saadi4,
  5. Julian Di Guilmi5,
  6. Clemente Arab Eblen6,
  7. Fernando Heredia Muñoz7 and
  8. Rene Pareja8,9,10
  1. 1 Department of Gynecologic Oncology, Instituto de Cancerología - Las Américas - AUNA, Medellín, Colombia
  2. 2 Department of Gynecologic Surgery, Instituto Nacional de Enfermedades Neoplásicas, Lima, Perú
  3. 3 Department of Gynecologic Oncology, Cancer Hospital of Buenos Aires Marie Curie, Univertsity of Buenos Aires, Buenos Aires, Argentina
  4. 4 Department of Gynecologic Oncology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
  5. 5 Department of Gynecologic Surgery, Hospital Británico de Buenos Aires, Buenos Aires, Argentina
  6. 6 Department of Gynecologic Surgery, Hospital Dr. Luis Tisné, Universidad de Chile, Santiago de Chile, Chile
  7. 7 Department of Gynecology and Obstetrics, Faculty of Medicine, Universidad de Concepción, Concepción, Chile
  8. 8 Department of Gynecologic Oncology, Clínica ASTORGA, Medellin, Colombia
  9. 9 Department of Gynecology and Obstetrics, Universidad Pontificia Bolivariana, Medellin, Antioquia, Colombia
  10. 10 Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Bogotá, Colombia
  1. Correspondence to Dr Gabriel J. Rendón, Department of Gynecologic Oncology, Instituto de Cancerología - Las Américas - AUNA, Medellin, Antioquia 050025, Colombia; gabrieljrendon{at}hotmail.com

Abstract

Objective There is significant debate between up-front radical trachelectomy versus neo-adjuvant chemotherapy before fertility-sparing surgery in patients with tumors ≥2 cm. The aim of this study was to report on the oncological and obstetrical outcome of neo-adjuvant chemotherapy followed by fertility-sparing surgery, in patients diagnosed with cervical cancer ≥2 cm.

Methods This was a retrospective review of patients diagnosed with cervical cancer measuring ≥2 cm to ≤6 cm, who were scheduled to undergo neo-adjuvant chemotherapy before fertility-sparing surgery, at six institutions from four Latin American countries between February 2009 and February 2019. Data collected included: age, International Federation of Gynecology and Obstetrics (FIGO) 2009 stage, histology, tumor size, pre-treatment imaging work-up, chemotherapy agents and number of cycles, toxicity, clinical and imaging response rate, type of fertility-sparing surgery, pathology results, timing of lymphadenectomy, follow-up time, and obstetrical and oncological outcomes.

Results A total of 25 patients were included, with a median age of 27 years (range 20–37): 17 patients had stage IB1, 7 had stage IB2 cervical cancer, and 1 patient had stage IIA1 (FIGO 2009); 23 patients had squamous cell carcinoma and 2 patients had adenocarcinoma. The median number of chemotherapy cycles was 3 (range 3–6) and no toxicity grade 3–4 was reported. Lymphadenectomy was performed before chemotherapy in 6 (24%) patients. After neo-adjuvant chemotherapy 20 patients were scheduled for radical trachelectomy (11 abdominal and 9 laparoscopic) and 5 patients for conization. After surgery, no residual disease was found in 11 patients (44%). Fertility was preserved in 23 patients (92%) and 10 patients became pregnant (43.5%). After a median follow-up time of 47 months (13–133), 3 patients had recurrent disease (3/23=13%), 2 were alive without disease, and 1 patient had disease at last contact.

Conclusion Neo-adjuvant chemotherapy followed by fertility-sparing surgery is feasible in well selected patients with cervical tumors ≥2 cm. Future studies should focus on the timing of lymphadenectomy and type of cervical surgery.

  • cervical cancer

https://doi.org/10.1136/ijgc-2020-002076

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    Footnotes

    • Twitter @GabrielJRendon

    • Contributors All authors contributed meaningfully to the conception or design of the work or the acquisition, analysis, or interpretation of data for the study. The authors confirm the completeness and accuracy of the data and analyses, the fidelity of the study to the protocol, and the final approval of the version to be published.

    • 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.

    • Data availability statement Data are available upon reasonable request.