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  • Fertility-sparing surgery after neo-adjuvant chemotherapy in women with cervical cancer larger than 4 cm: a systematic review

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Original research
Fertility-sparing surgery after neo-adjuvant chemotherapy in women with cervical cancer larger than 4 cm: a systematic review
  1. David Viveros-Carreño1,2,
  2. Juliana Rodriguez1,3,
  3. Gabriel Jaime Rendon Pereira4,
  4. Jiri Slama5,
  5. Michael J Halaska6,
  6. Helena Robova6 and
  7. Rene Pareja1,7
  1. 1 Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Bogotá, Colombia
  2. 2 Universidad Militar Nueva Granada, Bogota, Colombia
  3. 3 Department of Gynecology and Obstetrics, section of Gynecologic Oncology, Fundación Santa Fe de Bogotá, Bogotá, Colombia
  4. 4 Department of Gynecologic Oncology, Instituto de Cancerología - Las Américas - AUNA, Medellin, Antioquia, Colombia
  5. 5 Department of Obstetrics and Gynecology, Gynecologic Oncology Center, First Faculty of Medicine, Charles University and General University Hospital (Central and Eastern European Gynecologic Oncology Group, CEEGOG), Prague, Czech Republic
  6. 6 Department of Obstetrics and Gynaecology, 3rd Medical Faculty, Charles University, Prague, Czech Republic
  7. 7 Gynecologic Oncology, Clinica ASTORGA, Medellin, Colombia
  1. Correspondence to Dr David Viveros-Carreño, Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Bogotá, Colombia; dviverosc{at}gmail.com

Abstract

Objective The objective of this systematic review was to assess the oncologic and fertility outcomes of patients with cervix-confined cancer >4 cm who underwent neo-adjuvant chemotherapy followed by fertility-sparing surgery.

Methods This study was registered in PROSPERO (registration number CRD42021254816). PubMed/MEDLINE, ClinicalTrials, EMBASE, Cochrane Central Register of Controlled Trials, SCOPUS, and OVID databases were searched from inception to July 2021. The included patients were those with cancer confined to the cervix and tumor diameter >4 cm (International Federation of Gynecology and Obstetrics (FIGO) 2018 stage IB3) with squamous cell carcinoma, adenocarcinoma, or adenosquamous carcinoma who underwent intra-venous neo-adjuvant chemotherapy followed by successful fertility-sparing surgery.

Results The initial search identified 2990 articles. A total of 40 patients from 11 studies had attempted fertility preservation surgery (conization, simple or radical trachelectomy) and in 26 patients (65%) it was successful. All patients received platinum-based chemotherapy. A complete pathological response occurred in 56% of patients and two patients (7.7%) had a recurrence. The 4.5-year disease-free survival was 92.3% and the 4.5-year overall survival rate was 100%. Of six patients who tried to conceive, four (67%) achieved at least one pregnancy and three of the five pregnancies (60%) were pre-term deliveries (all after radical trachelectomy). All patients with recurrence received cisplatin and ifosfamide instead of cisplatin and paclitaxel, underwent non-radical surgery, and had residual disease in the final specimen.

Conclusions Evidence for fertility-sparing surgery after neo-adjuvant chemotherapy in patients with cervical cancer and tumors >4 cm is limited, and this approach should be considered as an experimental intervention. As the use of non-radical surgery could be a risk factor, if neo-adjuvant chemotherapy is used, patients should undergo fertility-sparing radical surgery.

  • cervical cancer

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

https://doi.org/10.1136/ijgc-2021-003297

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information.

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    Footnotes

    • Contributors DV-C: conceptualization, investigation, methodology, writing - original draft, writing - review, editing, and responsible for the overall content as guarantor. JR: data curation, formal analysis, investigation, methodology, writing - review, and editing. GJRP: data collection, drafting and editing review. JS: data collection, drafting and editing review. MJH: data collection, drafting and editing review. HR: data collection, drafting and editing review. RP: conceptualization, methodology, formal analysis, writing - review and editing, supervision.

    • 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.

    • 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.