Introduction/Background*According to current guidelines fertility-sparing treatment (FST) in cervical cancer patients should follow the same principles as in patients without fertility preservation. The literature from the last years, however, show a trend towards less-radical procedures. Although oncological outcomes are reported to be equal or better than in non-FST, published groups are small, mostly single institutional, inclusion criteria vary, and treatment is not uniform. The aim of this study was to collect retrospective data from multiple institutions across several countries on oncological and reproductive outcomes after FST.
Methodology Included were cervical cancer patients between 18–40 years with stages ≥ IA1+LVSI, who underwent any type of FST and completed follow-up of at least 6 months. Patients were eligible irrespective of neoadjuvant chemotherapy, histotype or tumour grade.
Result(s)*Altogether 733 patients from 44 centers in 13 countries were eligible for analyses. Median follow-up of the whole cohort was 6 years (1.2–14.5). More than half of the cases had stage IB1 (54.2%; 397/733). Mean age of patients was 32 years and two thirds were nulliparous (484/733). Most common surgical procedure was conization (48%). Repeated cervical surgery was performed in 161 patients (21.9%), most frequently re-conization (57.8%). Less than half of the patients (49.2%; 361/733) attempted to conceive after treatment. Out of them, 138 (38.2%) got pregnant and 100 (27.7%) successfully delivered. Pre-cancer recurrence was diagnosed in 22 (3%) patients, 51 (7%) patients had cancer recurrence and 19 (2.6%) died of disease. Three times higher risk of recurrence was observed in tumours ≥ 2 cm in comparison to smaller tumours (19.4% vs. 5.7%; p<0.001). The most frequent locations of recurrence were cervix (53%) and pelvic nodes (22%). Median DFI for invasive recurrence reached 18 months.
Conclusion*Data from the real life practice showed that FST in cervical cancer patients is safe in patients with HPV related tumours smaller than 2 cm. In such tumours conization represents sufficient procedure with satisfactory pregnancy outcomes. Surprisingly less than half of patients attempt to conceive after treatment.
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