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Original article
Fertility-sparing surgery of cervical cancer >2 cm (International Federation of Gynecology and Obstetrics 2009 stage IB1–IIA) after neoadjuvant chemotherapy
  1. Freweini Martha Tesfai1,
  2. Judith R Kroep2,
  3. Katja Gaarenstroom1,
  4. Cor De Kroon1,
  5. Rhiannon Van Loenhout3,
  6. Vincent Smit4,
  7. Baptist Trimbos1,
  8. R A Nout5,
  9. M I E van Poelgeest1 and
  10. Jogchum Jan Beltman1
  1. 1Gynecology, Leiden University Medical Center, Leiden, South-Holland, The Netherlands
  2. 2Medical Oncology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
  3. 3Radiology, Medisch Centrum Haaglanden Westeinde, Den Haag, Zuid-Holland, The Netherlands
  4. 4Pathology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
  5. 5Radiation Oncology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
  1. Correspondence to Dr Jogchum Jan Beltman, Gynecology, Leiden University Medical Center, Leiden, Zuid-Holland, Netherlands; j.j.beltman{at}lumc.nl

Abstract

Objective To assess the feasibility, safety, oncological, and obstetric outcomes in patients with cervical tumors >2 cm treated with neoadjuvant chemotherapy in preparation for abdominal radical trachelectomy.

Methods A retrospective analysis of patients with cervical cancer >2 cm (up to 6 cm) was conducted in patients who were selected to receive neoadjuvant chemotherapy before abdominal radical trachelectomy. Surgical and clinical outcomes were examined in relation to radiological and pathological results. In addition, obstetric outcomes were described. The Mann–Whitney U test and Fisher’s exact test were performed to compare radiological findings between successful and unsuccessful abdominal radical trachelectomy procedures. International Federation of Gynecology and Obstetrics (FIGO) 2009 staging classification was used for this study.

Results A total of 19 women were treated with neoadjuvant chemotherapy for cervical tumors >2 cm at our institution between May 2006 and July 2018. The median age was 28 years (range 19–36). The distribution of FIGO stages was seven patients stage IB1 (37%), 10 patients stage IB2 (53%), and two patients (10%) stage IIA. Mean clinical tumor size was 4.4 cm (range 3.5–6.0). Histology revealed 74% cases of squamous cell carcinoma. The remaining patients had adenocarcinoma (21%) and only one patient had clear cell adenocarcinoma (5%). Chemotherapy consisted of six weekly cycles of cisplatin (70 mg/m2) and paclitaxel (70 mg/m2). In 15 of the 19 patients (74%) fertility was successfully preserved. In the four patients in whom fertility preservation failed, one patient had stable disease after three cycles and did not meet the criteria for fertility-sparing surgery and three patients had intra- or post-operative indications for adjuvant therapy. Three of the 19 patients (15.7%) had a relapse, two of whom died. One case was in the group of successful abdominal radical trachelectomy.

Conclusion Neoadjuvant chemotherapy followed by fertility-sparing surgery may be a feasible and safe option in select patients with cervical tumors >2 cm. Unfavorable prognostic factors are defined as non-responsiveness and non-squamous pathology, which can help in patient selection for fertility-sparing surgery.

  • cervical cancer
  • uterine cervical neoplasms

https://doi.org/10.1136/ijgc-2019-000647

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    Footnotes

    • Contributors FMT: collecting data, analyzing, writing. RvL: providing data, reviewing. JJB, MIEvP, JRK, BT, KG: analyzing, reviewing and writing. CdK, RAN, VS: reviewing data.

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