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Theofanakis C, Koulakmanidis AM, Prodromidou A, Haidopoulos D, Rodolakis A, Thomakos N. Fertility-Sparing Treatment for Young Patients with Early-Stage Cervical Cancer: A Dawn of a New Era. Front Surg 2022; 9:867993. [PMID: 35599800 PMCID: PMC9120767 DOI: 10.3389/fsurg.2022.867993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 04/12/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Charalampos Theofanakis
- School of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
- Division of Gynaecologic Oncology, 1st Department of Obstetrics and Gynaecology, Alexandra Hospital, Athens, Greece
- Correspondence: Charalampos Theofanakis
| | - Aristotelis-Marios Koulakmanidis
- School of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
- Division of Gynaecologic Oncology, 1st Department of Obstetrics and Gynaecology, Alexandra Hospital, Athens, Greece
| | - Anastasia Prodromidou
- School of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
- Division of Gynaecologic Oncology, 1st Department of Obstetrics and Gynaecology, Alexandra Hospital, Athens, Greece
| | - Dimitrios Haidopoulos
- School of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
- Division of Gynaecologic Oncology, 1st Department of Obstetrics and Gynaecology, Alexandra Hospital, Athens, Greece
| | - Alexandros Rodolakis
- School of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
- Division of Gynaecologic Oncology, 1st Department of Obstetrics and Gynaecology, Alexandra Hospital, Athens, Greece
| | - Nikolaos Thomakos
- School of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
- Division of Gynaecologic Oncology, 1st Department of Obstetrics and Gynaecology, Alexandra Hospital, Athens, Greece
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Morice P, Maulard A, Scherier S, Sanson C, Zarokian J, Zaccarini F, Espenel S, Pautier P, Leary A, Genestie C, Chargari C, Grynberg M, Gouy S. Oncologic results of fertility sparing surgery of cervical cancer: An updated systematic review. Gynecol Oncol 2022; 165:169-183. [PMID: 35241291 DOI: 10.1016/j.ygyno.2022.01.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/12/2022] [Accepted: 01/17/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Several techniques can be proposed as fertility sparing surgery in young patients treated for cervical cancer but uncertaincies remain concerning their outcomes. Analysis of oncological issues is then the first aim of this review in order to evaluate the best strategy. RESULTS Data were identified from searches of MEDLINE, Current Contents, PubMed and from references in relevant articles from January 1987 to 15th of September 2021. We carry out an updated systematic review involving 5862 patients initially selected for fertility-sparing surgery in 275 series. FINDINGS In patients having a stage IB1 disease, recurrence rate/RR in patients undergoing simple conisation/trachelectomy, radical trachelectomy/RT by laparoscopico-vaginal approach, laparotomic or laparoscopic approaches are respectively: 4.1%, 4.7%, 2.4% and 5.2%. In patients having a stage IB2 disease, RR after neoadjuvant chemotherapy or RT by laparotomy are respectively 13.2% and 4.8% (p = .0035). After neoadjuvant treatment a simple cone/trachelectomy was carried out in 91 (30%) patients and a radical one in 210 (70%) cases. But the lowest pregnancy rate is observed in patients undergoing RT by laparotomy (36%). CONCLUSIONS The choice between these treatments should be based above all, on objective oncological data that strike a balance for each procedure between the best chances for cure and the fertility results. In patients having a stage IB1 disease, oncological results are quite similar according to the procedure used. In patients having a stage IB2 disease, RT by open approach has the lowest RR. Anyway the lowest pregnancy rate is observed in patients undergoing RT by laparotomy.
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Affiliation(s)
- P Morice
- Department of Gynecological Surgery, Gustave-Roussy, Villejuif, France; Inserm Unit 10-30, Gustave-Roussy, Villejuif, France; University Paris-Sud (Paris XI), Le Kremlin-Bicêtre, France.
| | - A Maulard
- Department of Gynecological Surgery, Gustave-Roussy, Villejuif, France
| | - S Scherier
- Department of Gynecological Surgery, Gustave-Roussy, Villejuif, France
| | - C Sanson
- Department of Gynecological Surgery, Gustave-Roussy, Villejuif, France
| | - J Zarokian
- Department of Gynecological Surgery, Gustave-Roussy, Villejuif, France
| | - F Zaccarini
- Department of Gynecological Surgery, Gustave-Roussy, Villejuif, France
| | - S Espenel
- Department of Radiation Oncology, Gustave-Roussy, Villejuif, France
| | - P Pautier
- Department of Medical Oncology, Gustave-Roussy, Villejuif, France
| | - A Leary
- Department of Medical Oncology, Gustave-Roussy, Villejuif, France; Inserm Unit 981, Gustave-Roussy, Villejuif, France
| | - C Genestie
- Department of Pathology, Gustave-Roussy, Villejuif, France
| | - C Chargari
- Inserm Unit 10-30, Gustave-Roussy, Villejuif, France; Department of Radiation Oncology, Gustave-Roussy, Villejuif, France
| | - M Grynberg
- University Paris-Sud (Paris XI), Le Kremlin-Bicêtre, France; Department of Reproductive Medicine, Hôpital Antoine-Béclère, Clamart, France
| | - S Gouy
- Department of Gynecological Surgery, Gustave-Roussy, Villejuif, France
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Bréban-Kehl M, Zaccarini F, Sanson C, Maulard A, Scherier S, Genestie C, Chargari C, Pautier P, Leary A, Balleyguier C, Morice P, Gouy S. [Fertility preservation in cervical cancer, analysis of 30 years of practice and immersion in future developments]. ACTA ACUST UNITED AC 2021; 50:62-68. [PMID: 34487915 DOI: 10.1016/j.gofs.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The strategy of fertility preservation (FP) in cervical cancer has been challenged for several years and a therapeutic de-escalation seems to be necessary. In this context, we evaluated the oncological, fertility and obstetric outcomes of surgical techniques performed in our centre for FP. METHODS This retrospective uni centric trial included 75 patients, managed at the Gustave Roussy Institute between 1995 and 2020, for cervical cancer (stage IB1 FIGO 2018) and having conducted a fertility preservation project after a complete pre-therapy work-up. The objective of this study was to understand our results on fertility and obstetrical outcomes and to correlate them with oncological data and finally to evaluate the evolution of our surgical practices. RESULTS 54 patients benefited from an extended trachelectomy and no lymph node involvement was found. 1 patient received a complementary treatment postoperatively which did not allow to preserve her fertility. The recurrence rate was 4.8% (4/75) with one death described. 31 pregnancies were obtained, representing a pregnancy rate of 50%. 74% of pregnancies were obtained spontaneously and 60% of pregnancies were carried to term. CONCLUSION Our results are similar to those in the literature. Despite a fertility preservation project, only half of the patients were able to achieve a pregnancy.
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Affiliation(s)
- M Bréban-Kehl
- Département de chirurgie gynécologique, Institut Gustave Roussy, 114, rue Edouard Vaillant, 94805 Villejuif Cedex, France
| | - F Zaccarini
- Département de chirurgie gynécologique, Institut Gustave Roussy, 114, rue Edouard Vaillant, 94805 Villejuif Cedex, France
| | - C Sanson
- Département de chirurgie gynécologique, Institut Gustave Roussy, 114, rue Edouard Vaillant, 94805 Villejuif Cedex, France
| | - A Maulard
- Département de chirurgie gynécologique, Institut Gustave Roussy, 114, rue Edouard Vaillant, 94805 Villejuif Cedex, France
| | - S Scherier
- Département de chirurgie gynécologique, Institut Gustave Roussy, 114, rue Edouard Vaillant, 94805 Villejuif Cedex, France
| | - C Genestie
- Département d'anatomopathologie, Institut Gustave Roussy, Villejuif, France
| | - Cyrus Chargari
- Département de radiothérapie, Institut Gustave Roussy, Villejuif, France
| | - P Pautier
- Département d'oncologie médicale, Institut Gustave Roussy, Villejuif, France; Unité Inserm U 981 Gustave Roussy, Villejuif, France
| | - A Leary
- Département d'oncologie médicale, Institut Gustave Roussy, Villejuif, France; Unité Inserm U 981 Gustave Roussy, Villejuif, France
| | - C Balleyguier
- Département de radiologie, Institut Gustave Roussy, Villejuif, France
| | - P Morice
- Département de chirurgie gynécologique, Institut Gustave Roussy, 114, rue Edouard Vaillant, 94805 Villejuif Cedex, France; Unité Inserm U 10-30, Gustave Roussy, Villejuif, France; Université Paris-Sud (Paris XI), Le Kremlin Bicêtre, France
| | - S Gouy
- Département de chirurgie gynécologique, Institut Gustave Roussy, 114, rue Edouard Vaillant, 94805 Villejuif Cedex, France; Unité Inserm U 10-30, Gustave Roussy, Villejuif, France; Université Paris-Sud (Paris XI), Le Kremlin Bicêtre, France.
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4
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Ind T. Radical vaginal trachelectomy. Best Pract Res Clin Obstet Gynaecol 2021; 75:65-71. [PMID: 34099413 DOI: 10.1016/j.bpobgyn.2021.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 04/30/2021] [Indexed: 10/21/2022]
Abstract
Radical vaginal trachelectomy (RVT) is the oldest fertility-sparing procedure for stage 1b cervical cancer. For that reason, there are more published data for RVT than for all the other radical trachelectomy approaches. However, there are no randomised controlled studies between RVT and radical hysterectomy proving the comparability of survival and no randomised controlled studies comparing a vaginal approach with open, standard laparoscopy and robotic approaches. This article intends to describe the case selection, the procedure and outcomes for RVT.
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Affiliation(s)
- Thomas Ind
- Royal Marsden Hospital, London, SW3 6JA, UK; St George's University of London, Cranmer Terrace, Tooting, London SW17 0RE, UK.
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5
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Ronsini C, Anchora LP, Restaino S, Fedele C, Arciuolo D, Teodorico E, Bizzarri N, Zannoni GF, Ferrandina G, Scambia G, Fanfani F. The role of semiquantitative evaluation of lympho-vascular space invasion in early stage cervical cancer patients. Gynecol Oncol 2021; 162:299-307. [PMID: 34116834 DOI: 10.1016/j.ygyno.2021.06.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/05/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Lymph vascular space involvement (LVSI) is one of the most important prognostic factors in early stage cervical cancer. Its qualitative evaluation represents a milestone for patient risk stratification and treatment choice, but a semi-quantitative analysis of LVSI may offer a more truthful risk model, as already demonstrated for endometrial cancer. The present study aims to investigate the performances of a semi-quantitative evaluation of LVSI in terms of patient risk assessment. METHODS In this retrospective study were enrolled patients underwent surgical treatment for early cervical cancer from January 2009 to October 2018. A semi-quantitative evaluation such as the "three-tiered approach" was used to classify the LVSI pathway: negative vs. focal vs. diffuse. RESULTS Diffuse LVSI was found to be a risk factor for lymph node metastasis (OR: 9.844, p < 0.001), and parametrial involvement (OR: 5.566, p < 0.001). Lymph nodal recurrences were more frequent in diffuse LVSI group (LVSI negative vs. focal LVSI p = 0.369; LVSI negative vs. diffuse LVSI p = 0.002; Focal LVSI vs. diffuse LVSI p = 0.214); and so distant recurrences (LVSI negative vs. focal LVSI p = 0.623; LVSI negative vs. diffuse LVSI p = 0.002; Focal LVSI vs. diffuse LVSI p = 0.026). Patients with diffuse LVSI showed a worse disease-free survival (DFS) than patients with focal or absent involvement (DFS LVSI negative vs. focal LVSI p = 0.938; LVSI negative vs. diffuse LVSI p < 0.001; focal LVSI vs. diffuse LVSI p = 0.036). CONCLUSION Semi-quantitative evaluation of LVSI may be useful to identify risk patients for shorter disease-free survival and lymphatic and distant recurrences in patients with early stage.
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Affiliation(s)
- Carlo Ronsini
- Unit of Gynecologic Oncology, Department of Woman, Child and Public Health, A. Gemelli, IRCCS, University Hospital Foundation, Rome, Italy; Catholic University of the Sacred Heart, Rome, Italy
| | - Luigi Pedone Anchora
- Unit of Gynecologic Oncology, Department of Woman, Child and Public Health, A. Gemelli, IRCCS, University Hospital Foundation, Rome, Italy
| | - Stefano Restaino
- Gynecoloy and Obstetrics Department, ASUFC University-Hospital of Central Friuli, ASUFC, Udine, Italy
| | - Camilla Fedele
- Unit of Gynecologic Oncology, Department of Woman, Child and Public Health, A. Gemelli, IRCCS, University Hospital Foundation, Rome, Italy; Catholic University of the Sacred Heart, Rome, Italy
| | - Damiano Arciuolo
- Unit of Gyneco-Pathology and Breast Pathology, Department of Women's Health, Childhood and Public Health Sciences, A. Gemelli IRCCS University Hospital Foundation, Rome, Italy
| | - Elena Teodorico
- Unit of Gynecologic Oncology, Department of Woman, Child and Public Health, A. Gemelli, IRCCS, University Hospital Foundation, Rome, Italy
| | - Nicolò Bizzarri
- Unit of Gynecologic Oncology, Department of Woman, Child and Public Health, A. Gemelli, IRCCS, University Hospital Foundation, Rome, Italy
| | - Gian Franco Zannoni
- Unit of Gyneco-Pathology and Breast Pathology, Department of Women's Health, Childhood and Public Health Sciences, A. Gemelli IRCCS University Hospital Foundation, Rome, Italy; Institute of Pathological Anatomy, Catholic University of the Sacred Heart, Rome, Italy
| | - Gabriella Ferrandina
- Unit of Gynecologic Oncology, Department of Woman, Child and Public Health, A. Gemelli, IRCCS, University Hospital Foundation, Rome, Italy; Catholic University of the Sacred Heart, Rome, Italy
| | - Giovanni Scambia
- Unit of Gynecologic Oncology, Department of Woman, Child and Public Health, A. Gemelli, IRCCS, University Hospital Foundation, Rome, Italy; Catholic University of the Sacred Heart, Rome, Italy.
| | - Francesco Fanfani
- Unit of Gynecologic Oncology, Department of Woman, Child and Public Health, A. Gemelli, IRCCS, University Hospital Foundation, Rome, Italy; Catholic University of the Sacred Heart, Rome, Italy
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Fertility-Sparing Surgery in Gynecologic Cancer: A Systematic Review. Cancers (Basel) 2021; 13:cancers13051008. [PMID: 33670929 PMCID: PMC7975326 DOI: 10.3390/cancers13051008] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 12/15/2022] Open
Abstract
Fertility-sparing surgery (FSS) is increasingly being offered to women with a gynecological malignancy who wish to preserve fertility. In this systematic review, we evaluate the best evidence currently available on oncological and reproductive outcome after FSS for early stage cervical cancer, epithelial ovarian cancer, and endometrial cancer. An extensive literature search was conducted using the electronic databases Medline (OVID), Embase, and Cochrane Library to identify eligible studies published up to December 2020. In total, 153 studies were included with 7544, 3944, and 1229 patients who underwent FSS for cervical, ovarian, and endometrial cancer, respectively. We assessed the different FSS techniques that are available to preserve fertility, i.e., omitting removal of the uterine body and preserving at least one ovary. Overall, recurrence rates after FSS are reassuring and therefore, these conservative procedures seem oncologically safe in the current selection of patients with low-stage and low-grade disease. However, generalized conclusions should be made with caution due to the methodology of available studies, i.e., mostly retrospective cohort studies with a heterogeneous patient population, inducing selection bias. Moreover, about half of patients do not pursue pregnancy despite FSS and the reasons for these decisions have not yet been well studied. International collaboration will facilitate the collection of solid evidence on FSS and the related decision-making process to optimize patient selection and counseling.
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Fertility-Sparing Surgery for Early-Stage Cervical Cancer: A Systematic Review of the Literature. J Minim Invasive Gynecol 2020; 28:513-526.e1. [PMID: 33223017 DOI: 10.1016/j.jmig.2020.10.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/20/2020] [Accepted: 10/23/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This systematic review aimed to evaluate oncologic and reproductive outcomes after fertility-sparing surgery (FSS) for early-stage cervical cancer (early CC). DATA SOURCES Ovid MEDLINE, Ovid EMBASE, and Cochrane CENTRAL were searched from 1980 to the present using Medical Subject Headings terms; other controlled vocabulary terms; and keywords related to fertility, cervical cancer, and surgical techniques. METHODS OF STUDY SELECTION A total of 2415 studies were screened, with 53 studies included. Studies reporting recurrences with a median follow-up of 12 months in early CC (International Federation of Gynecology and Obstetrics 2009 stages IA with lymphovascular space invasion, IB, or IIA) of traditional histologic type undergoing FSS were included. TABULATION, INTEGRATION, AND RESULTS The studies were grouped by intervention, including vaginal radical trachelectomy (VRT), abdominal radical trachelectomy (ART), minimally invasive radical trachelectomy (MIS-RT), and conization or simple trachelectomy (ST), and studies involving neoadjuvant chemotherapy (NACT). Combined rates of recurrence (RR), cancer death (CDR), pregnancy (PR), and live birth (LBR) were calculated per procedure on the basis of all included studies that reported outcomes on that procedure. The results were as follows: VRT: RR 4%, CDR 1.7%, PR 49.4%, and LBR 65.0% ART: RR 3.9%, CDR 1.4%, PR 43.2%, and LBR 44.0% MIS-RT: RR 4.2%, CDR 0.7%, PR 36.2%, and LBR 57.1% Cone or ST: RR 4.2%, CDR 0.8%, PR 55.1%, and LBR 71.9% NACT: RR 7.5% and CDR 2.0% CONCLUSION: FSS of early CC with VRT, ART, or MIS-RT have comparable oncologic outcomes in carefully selected patients, with reproductive outcomes favoring VRT. Data on nonradical FSS with cone or ST are less robust but support similar oncologic outcomes to radical trachelectomy with fewer reproductive complications. NACT in this setting requires more investigation before routine implementation into practice.
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Reed N, Balega J, Barwick T, Buckley L, Burton K, Eminowicz G, Forrest J, Ganesan R, Harrand R, Holland C, Howe T, Ind T, Iyer R, Kaushik S, Music R, Sadozye A, Shanbhag S, Siddiqui N, Syed S, Percival N, Whitham NL, Nordin A, Fotopoulou C. British Gynaecological Cancer Society (BGCS) cervical cancer guidelines: Recommendations for practice. Eur J Obstet Gynecol Reprod Biol 2020; 256:433-465. [PMID: 33143928 DOI: 10.1016/j.ejogrb.2020.08.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 08/05/2020] [Accepted: 08/21/2020] [Indexed: 01/20/2023]
Abstract
Cervix cancer in many countries is declining and screening programmes and immunisation will reduce the incidence in the next few decades. This guideline attempts to cover management of invasive disease reflecting diagnosis and imaging including new imaging and sentinel lymph node biopsies. Smaller volume disease is usually managed surgically whereas advanced disease is treated with (chemo)- radiation. It also includes discussion of fertility sparing procedures. Practices are changing frequently for all aspects of care usually in attempts to reduce complications and improve quality of life. The management of advanced disease is treated by chemotherapy and the use of newer agents is also discussed. Other sections discuss specialist situations such as cancer in pregnancy, rare cervical tumours, late effects and supportive measures and fertility preserving approaches.
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Affiliation(s)
- Nick Reed
- Beatson Oncology Centre, Glasgow, United Kingdom.
| | | | | | - Lynn Buckley
- Clinical Nurse Specialist, Hull University Teaching Hospitals NHS Trust, United Kingdom
| | | | | | | | | | | | | | | | - Thomas Ind
- Royal Marsden Hospital, London, United Kingdom
| | - Rema Iyer
- East Kent Hospitals University Foundation NHS Trust, United Kingdom
| | | | - Robert Music
- Jo's Cervical Cancer Trustt, London, United Kingdom
| | | | - Smruta Shanbhag
- University Hospitals Coventry and Warwickshire NHS Trust, United Kingdom
| | | | - Sheeba Syed
- Queen Elizabeth University Hospital, Glasgow, United Kingdom
| | | | - Natasha Lauren Whitham
- Lancashire Teaching Hospitals (Royal Preston Hospital, Fulwood, Lancashire), United Kingdom
| | - Andy Nordin
- East Kent Gynaecological Oncology Centre, East Kent Hospitals University Foundation Nhs Trust, Queen Elizabeth The Queen Mother Hospital, Margate, United Kingdom
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Nezhat C, Roman RA, Rambhatla A, Nezhat F. Reproductive and oncologic outcomes after fertility-sparing surgery for early stage cervical cancer: a systematic review. Fertil Steril 2020; 113:685-703. [DOI: 10.1016/j.fertnstert.2020.02.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 01/25/2020] [Accepted: 02/03/2020] [Indexed: 12/21/2022]
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Zhang Q, Li W, Kanis MJ, Qi G, Li M, Yang X, Kong B. Oncologic and obstetrical outcomes with fertility-sparing treatment of cervical cancer: a systematic review and meta-analysis. Oncotarget 2018; 8:46580-46592. [PMID: 28418849 PMCID: PMC5542294 DOI: 10.18632/oncotarget.16233] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 02/06/2017] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The objectives of this study were to evaluate the rates of recurrence, survival and pregnancy, and characterize pregnancy outcomes of early-stage cervical cancer(eCC) treated with fertility-sparing methods such as cervical conization (CON) and radical trachelectomy(RT) with or without pelvic lymphadenectomy. STUDY DESIGN This was a meta-analysis of observational studies analyzed by a random-effects model and a meta-regression to assess heterogeneity. RESULTS Sixty observational studies encompassing 2,854 patients were included; 17 of which evaluated CON and 43 RT. Three hundred and seventy-five patients were included in the CON group: 176(46.9%) stage IA1 and 167(44.5%) stage IB1. In the RT group, 2479 cases were included: 143(6.0%) stage IA1, 299(12.1%) stage IA2, 1987(79.9%) stage IB1. CON was performed in 347(92.5%) cases, resulting in a recurrence rate of 0.4%(95%CI: 0.0%-1.4%), a death rate of 0%(0%-0%), a pregnancy rate of 36.1%(26.4%-46.2%), a spontaneous abortion rate of 14.8%(9.3%-21.2%) and a preterm delivery rate of 6.8%(1.5%-15.5%). For the RT group, 2273(91.7%) underwent successful surgeries with a recurrence rate of 2.3%(1.3%-3.4%),a death rate of 0.7%(0.3%-1.1%), a pregnancy rate of 20.5%(16.8%-24.5%), a spontaneous abortion rate of 24.0%(18.8%-29.6%) and a preterm delivery rate of 26.6%(19.6%-34.2%). From a subgroup analysis, the recurrence rates for stage IA tumors treated with CON and RT were 0.4%(0.0%-1.9%) and 0.7%(0.0%-2.3%), respectively; and for stage IB were 0.6%(0.0%-2.7%) and 2.3%(0.9%-4.1%). CONCLUSION Fertility-sparing treatment including CON or RT for eCC is feasible and carefully selected women can preserve fertility and achieve pregnancy resulting in live births. CON seems to result in better pregnancy outcomes than RT with similar rates of recurrence and mortality.
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Affiliation(s)
- Qing Zhang
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Ji'nan, Shandong, P.R. China.,Gynecology Oncology Key Laboratory, Qilu Hospital, Shandong University, Ji'nan, Shandong, P.R. China
| | - Wenhui Li
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Ji'nan, Shandong, P.R. China.,Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, P.R. China
| | - Margaux J Kanis
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Gonghua Qi
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Ji'nan, Shandong, P.R. China
| | - Minghao Li
- Shandong University School of Medicine, Ji'nan, Shandong, P.R. China
| | - Xingsheng Yang
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Ji'nan, Shandong, P.R. China
| | - Beihua Kong
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Ji'nan, Shandong, P.R. China.,Gynecology Oncology Key Laboratory, Qilu Hospital, Shandong University, Ji'nan, Shandong, P.R. China
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Bentivegna E, Maulard A, Pautier P, Chargari C, Gouy S, Morice P. Fertility results and pregnancy outcomes after conservative treatment of cervical cancer: a systematic review of the literature. Fertil Steril 2016; 106:1195-1211.e5. [DOI: 10.1016/j.fertnstert.2016.06.032] [Citation(s) in RCA: 114] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 06/09/2016] [Accepted: 06/20/2016] [Indexed: 01/17/2023]
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13
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Bentivegna E, Gouy S, Maulard A, Chargari C, Leary A, Morice P. Oncological outcomes after fertility-sparing surgery for cervical cancer: a systematic review. Lancet Oncol 2016; 17:e240-e253. [DOI: 10.1016/s1470-2045(16)30032-8] [Citation(s) in RCA: 136] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 03/17/2016] [Accepted: 03/20/2016] [Indexed: 12/16/2022]
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14
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Hauerberg L, Høgdall C, Loft A, Ottosen C, Bjoern S, Mosgaard B, Nedergaard L, Lajer H. Vaginal Radical Trachelectomy for early stage cervical cancer. Results of the Danish National Single Center Strategy. Gynecol Oncol 2015; 138:304-10. [DOI: 10.1016/j.ygyno.2015.05.016] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 05/20/2015] [Accepted: 05/20/2015] [Indexed: 10/23/2022]
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