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2022-RA-689-ESGO Fertility-sparing treatment in patients with IB1 cervical cancer – results of the international multicentre retrospective FERTISS study (ENGOT Cx14; CEEGOG Cx-03)
  1. Jiri Slama1,
  2. Ingo Runnebaum2,
  3. Giovanni Scambia3,
  4. Martina Aida Angeles4,
  5. Kiarash Bahrehmand5,
  6. Stefan Kommoss6,
  7. Anna Fagotti3,
  8. Fabrice Narducci7,
  9. Olga Matylevich8,
  10. Jessica Holly9,
  11. Fabio Martinelli10,
  12. Meriem Koual11,
  13. Viacheslav Kopetskyi12,
  14. Ahmed El-Balat13,
  15. Giacomo Corrado3,
  16. Mihai Emil Capilna14,
  17. Willibald Schroder15,
  18. Zoltan Novak5,
  19. Alexander Shushkevich8,
  20. Lenka Fricova1 and
  21. David Cibula16
  1. 1Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
  2. 2Department of Gynecology and Reproductive Medicine, Jena University Hospital, Friedrich Schiller University, Jena, Germany
  3. 3Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University of the Sacred Heart Rome, Rome, Italy
  4. 4Claudius Regaud Institute – University Cancer Institute, Toulouse, France
  5. 5Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary
  6. 6Department of Women’s Health, Tuebingen University Hospital, Tuebingen, Germany
  7. 7Department of Gynecology Oncology, Oscar Lambret Cancer Center, Lille, France
  8. 8Gynecologic Oncology Department, N.N. Alexandrov National Cancer Centre of Belarus, Minsk, Belarus
  9. 9Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Essen, Germany
  10. 10Fondazione IRCCS Istituto Nazionale Tumori – Milan, Milan, Italy
  11. 11Gynecologic and Breast Oncologic Surgery Department, Georges Pompidou European Hospital, Paris, France
  12. 12Department of Gynecologic Oncology, National Cancer Institute, Department of Gynecologic Oncology, National Cancer Institute, Kyiv, Ukraine
  13. 13Department of Gynecology and Obstetrics, University Clinic Frankfurt, Goethe-University; Spital Uster, Women´s Hospital, Uster, Switzerland
  14. 14First Obstetrics and Gynecology Clinic, ‘George Emil Palade’ University of Medicine, Pharmacy, Science and Technology Târgu Mureş, Târgu Mureş, Romania
  15. 15Gynaekologicum Bremen, Bremen, Germany
  16. 16Department of Gynecology and Obstetrics, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic


Introduction/Background One of the key conditions for selecting candidates for fertility sparing treatment (FST) is a tumour size not exceeding 2 cm in the largest dimension. While there is a consensus on the choice of surgical treatment in stage IA, both radical (radical trachelectomy) and non-radical (simple trachelectomy or conisation) procedures are advocated in stage IB1, often depending on tumor size (>1 cm vs. 1–2 cm) and the presence of LVSI.

Methodology Patients with IB1 cervical cancer were recruited from the international multicenter retrospective FERTISS study. Inclusion criteria were lymph node negativity, age 18–40 years, and any type of FST, regardless of neoadjuvant chemotherapy, histotype, or tumour grade. Parameters representing disease and treatment characteristics were analyzed for risk of recurrence.

Results A total of 356 stage IB1 patients from 44 institutions in 13 countries were enrolled in the study. The mean age of the patients was 31.7 years, 70.2% of them were nulliparous. One-third of the tumours were adenocarcinomas and one-third of cases were LVSI positive. Oncological treatment characteristics are summarized in table 1. During median follow-up of 72 months there were 27 recurrences (7.6%) and 8 deaths (2.3%) from the disease. Recurrence rates did not differ between patients after non-radical cervical procedures (conization or simple trachelectomy) and radical trachelectomy (7.5% vs. 7.7%; p=0.957), even after subgroup analysis according to tumour size (<1 cm: 5.2% vs. 7.4%; p=0.507; 1–2 cm: 10.9% vs. 8%; p=0.553) or presence of LVSI (11.5% vs. 9.4%; p=0.725) (table 2).

Abstract 2022-RA-689-ESGO Table 1

Overview of oncological treatment

Abstract 2022-RA-689-ESGO Table 2

Recurrences risk according to different radicality of FST

Conclusion We have demonstrated that in patients with HPV-associated tumour types, negative regional lymph nodes, and tumour size ≤2 cm, oncological outcome after FST is excellent, and it is not inferior after non-radical cervical procedures.

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