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Kohler C, Plaikner A, Siegler K, Hertel H, Hasenbein K, Petzel A, Schubert M, Blohmer JU, Böhmer G, Stolte C, Marnitz S, Mallmann-Gottschalk N, Oppelt P, Favero G, Westphalen S, Hagemann I, Martus P, Schneider A. Radical vaginal trachelectomy: long-term oncologic and fertility outcomes in patients with early cervical cancer. Int J Gynecol Cancer 2024; 34:799-805. [PMID: 38599782 PMCID: PMC11187360 DOI: 10.1136/ijgc-2024-005274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 03/18/2024] [Indexed: 04/12/2024] Open
Abstract
OBJECTIVE Radical vaginal trachelectomy is a fertility-preserving treatment for patients with early cervical cancer. Despite encouraging oncologic and fertility outcomes, large studies on radical vaginal trachelectomy are lacking. METHOD Demographic, histological, fertility, and follow-up data of consecutive patients who underwent radical vaginal trachelectomy between March 1995 and August 2021 were prospectively recorded and retrospectively analyzed. RESULTS A total of 471 patients of median age 33 years (range 21-44) were included. 83% (n=390) were nulliparous women. Indications were International Federation of Gynecology and Oncology (FIGO, 2009) stages IA1 with lymphvascular space involvement (LVSI) in 43 (9%) patients, IA1 multifocal in 8 (2%), IA2 in 92 (20%), IB1 in 321 (68%), and IB2/IIA in 7 (1%) patients, respectively. LVSI was detected in 31% (n=146). Lymph node staging was performed in 151 patients (32%) by the sentinel node technique with a median of 7 (range 2-14) lymph nodes and in 320 (68%) by systematic lymphadenectomy with a median of 19 (range 10-59) lymph nodes harvested. Residual tumor was histologically confirmed in 29% (n=136). In total, 270 patients (62%) were seeking pregnancy of which 196 (73%) succeeded. There were 205 live births with a median fetal weight of 2345 g (range 680-4010 g). Pre-term delivery occurred in 94 pregnancies (46%). After a median follow-up of 159 months (range 2-312), recurrences were detected in 16 patients (3.4%) of which 43% occurred later than 5 years after radical vaginal trachelectomy. Ten patients (2.1%) died of disease (five more than 5 years after radical vaginal trachelectomy). Overall survival, disease-free survival, and cancer-specific survival were 97.5%, 96.2%, and 97.9%, respectively. CONCLUSION Our study confirms oncologic safety of radical vaginal trachelectomy associated with a high chance for childbearing. High rate of pre-term delivery may be due to cervical volume loss. Our long-term oncologic data can serve as a benchmark for future modifications of fertility-sparing surgery.
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Affiliation(s)
- Christhardt Kohler
- Department of Gynecology, Asklepios Clinic Altona, Hamburg, Germany
- Institute for Dysplasia and Cytology, MVZ Fürstenbergkarree, Berlin, Germny
| | - Andrea Plaikner
- Department of Gynecology, Asklepios Clinic Altona, Hamburg, Germany
| | - Kathrin Siegler
- Department of Gynecology, Asklepios Clinic Altona, Hamburg, Germany
| | - Hermann Hertel
- Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany
| | - Kati Hasenbein
- Specialized Medical Practice for Gynecologic Oncology, Berlin-Spandau, Berlin, Germany
| | - Anja Petzel
- Institute for Dysplasia and Cytology, MVZ Kreuzberg, Berlin, Germany
| | - Melanie Schubert
- Gynecology and Obstetrics, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | | | - Gerd Böhmer
- Institute for Dysplasia and Cytology, IZD Hannover, Hannover, Germany
| | - Claudia Stolte
- Institute for Dysplasia and Cytology, IZD Hannover, Hannover, Germany
| | - Simone Marnitz
- Radiation Oncology Vosspalais, Private Clinic, Berlin, Germany
| | - Nina Mallmann-Gottschalk
- Department of Gynecology and Obstetrics, University Hospital of Cologne Medical Faculty, Cologne, Germany
| | - Peter Oppelt
- Department for Gynecology, Obstetrics and Gynecological Endocrinology, Johannes Kepler University Linz, Linz, Austria
| | - Giovanni Favero
- Department of Gynecology and Obstetrics, Asklepios Hospital Lich, Lich, Germany
| | - Silke Westphalen
- Specialized Medical Practice for Dysplasia and Cytology, Lüneburg, Germany
| | - Ingke Hagemann
- Specialized Medical Practice for Dysplasia and Cytology, Kronshagen, Germany
| | - Peter Martus
- Institute for Clinical Epidemiology and Biometry, Eberhard Karls University Tübingen Faculty of Medicine, Tubingen, Germany
| | - Achim Schneider
- Institute for Dysplasia and Cytology, MVZ Fürstenbergkarree, Berlin, Germny
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2
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D’Amato A, Riemma G, Agrifoglio V, Chiantera V, Laganà AS, Mikuš M, Dellino M, Maglione A, Faioli R, Giannini A, Trojano G, Etrusco A. Reproductive Outcomes in Young Women with Early-Stage Cervical Cancer Greater than 2 cm Undergoing Fertility-Sparing Treatment: A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:608. [PMID: 38674254 PMCID: PMC11051883 DOI: 10.3390/medicina60040608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/03/2024] [Accepted: 04/05/2024] [Indexed: 04/28/2024]
Abstract
Background and Objectives: Despite advancements in detection and treatment, cervical cancer remains a significant health concern, particularly among young women of reproductive age. Limited data exists in the literature regarding fertility-sparing treatment (FST) of cervical cancers with tumor sizes greater than 2 cm. The objective of this systematic review was to evaluate the reproductive outcomes of women diagnosed with cervical cancer greater than 2 cm who underwent FST. Materials and Methods: A comprehensive search of the literature was carried out on the following databases: MEDLINE, EMBASE, Global Health, The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Cochrane Methodology Register), the Health Technology Assessment Database, and Web of Science. Only original studies (retrospective or prospective) that reported reproductive outcomes of patients with cervical cancer >2 cm were considered eligible for inclusion in this systematic review (CRD42024521964). Studies describing only the oncologic outcomes, involving FST for cervical cancers less than 2 cm in size, and case reports were excluded. Results: Seventeen papers that met the abovementioned inclusion criteria were included in the present systematic review. In total, 443 patients with a cervical cancer larger than 2 cm were included in this systematic review. Eighty pregnancies occurred, with 24 miscarriages and 54 live births. Conclusions: FST appears to be a viable option for women of childbearing age diagnosed with cervical cancer larger than 2 cm. However, careful consideration is advised in interpreting these encouraging results, as they are subject to limitations, such as variability in study designs and potential biases. In addition, reproductive outcomes should be further cross-referenced with oncologic outcomes to clarify the potential risk-benefit ratio. It is critical to conduct further research using standardized approaches and larger participant groups to strengthen the validity of the conclusions drawn.
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Affiliation(s)
- Antonio D’Amato
- Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine (DIM), University of Bari “Aldo Moro”, Policlinico of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy; (A.D.); (M.D.)
| | - Gaetano Riemma
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
| | - Vittorio Agrifoglio
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy; (V.A.); (V.C.); (A.E.)
- Unit of Obstetrics and Gynecology, “Paolo Giaccone” Hospital, 90127 Palermo, Italy
| | - Vito Chiantera
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy; (V.A.); (V.C.); (A.E.)
- Unit of Gynecologic Oncology, National Cancer Institute—IRCCS—Fondazione “G. Pascale”, 81031 Naples, Italy
| | - Antonio Simone Laganà
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy; (V.A.); (V.C.); (A.E.)
- Unit of Obstetrics and Gynecology, “Paolo Giaccone” Hospital, 90127 Palermo, Italy
| | - Mislav Mikuš
- Department of Obstetrics and Gynecology, Clinical Hospital Center Zagreb, 10 000 Zagreb, Croatia;
| | - Miriam Dellino
- Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine (DIM), University of Bari “Aldo Moro”, Policlinico of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy; (A.D.); (M.D.)
| | - Annamaria Maglione
- Gynecology and Obstetrics Unit, IRCCS “Casa del Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy; (A.M.); (R.F.)
| | - Raffaele Faioli
- Gynecology and Obstetrics Unit, IRCCS “Casa del Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy; (A.M.); (R.F.)
| | - Andrea Giannini
- Unit of Gynecology, “Sant’Andrea” Hospital, Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome, 00189 Rome, Italy;
| | - Giuseppe Trojano
- Department of Obstetrics and Gynecology, “Madonna delle Grazie” Hospital, 75100 Matera, Italy;
| | - Andrea Etrusco
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy; (V.A.); (V.C.); (A.E.)
- Unit of Obstetrics and Gynecology, “Paolo Giaccone” Hospital, 90127 Palermo, Italy
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3
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Siegler K, Plaikner A, Hertel H, Hasenbein K, Petzel A, Schubert M, Blohmer JU, Böhmer G, Marnitz S, Ragosch V, Domröse C, Oppelt P, Jülicher A, Schneider A, Willems A, Favero G, Köhler C. Oncologic and Fertility Outcomes After Simple Trachelectomy in Women With Early Cervical Cancer. J Minim Invasive Gynecol 2024; 31:110-114. [PMID: 37951567 DOI: 10.1016/j.jmig.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/16/2023] [Accepted: 11/07/2023] [Indexed: 11/14/2023]
Abstract
STUDY OBJECTIVE This study aimed to present our case series of patients with early-stage cervical cancer undergoing simple trachelectomy (ST). Currently, radical trachelectomy is considered the most appropriate fertility-preserving procedure for the treatment of early-stage cervical cancer. However, there is increasing debate on the appropriate radicality of the surgery to preserve oncologic safety. DESIGN Descriptive retrospective analysis of patient records and evaluation of questionnaires. SETTING 2 gynecologic oncologic centers, surgeries performed by one surgical team. PATIENTS 36 women with early-stage cervical cancer undergoing ST. INTERVENTIONS Laparoscopic assisted simple vaginal trachelectomy. MEASUREMENTS Demographic, histologic, fertility, and follow-up data of all patients who underwent ST between April 2007 and July 2021 were prospectively recorded and retrospectively analyzed. MAIN RESULTS A total of 36 women (mean age: 28 years) underwent ST of whom 81% were nulliparous. Indications for ST were multifocal International Federation of Gynecology and Obstetrics stage IA1 (n = 30), stage IA1 L1 (n = 1), stage IA2 (n = 2), and stage IB1 (n = 3). Mandatory staging procedure was laparoscopic pelvic lymphadenectomy, including bilateral sentinel biopsy in 92% of the cases and systematic in 8%. Residual tumor was histologically confirmed in 8 specimens (22%); 18 women (50%) were seeking parenthood, and 13 succeeded (72%). There were 16 live births, all on term, with a median fetal weight of 3110 grams (2330-4420). One patient had a medical abortion owing to fetal congenital malformation. One pregnancy is ongoing. After a median follow-up of 91.5 months (9-174), all women are alive with no evidence of disease. CONCLUSION ST represents a de-escalation compared with radical trachelectomy and provides excellent oncologic results with an outstanding fertility rate and obstetric outcome for patients with early cervical cancer. However, clear indications for this tailored fertility-preserving surgery have to be defined in well-designed trials.
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Affiliation(s)
- Kathrin Siegler
- Department of Gynecology (Drs. Siegler, Plaikner, and Köhler)
| | - Andrea Plaikner
- Department of Gynecology (Drs. Siegler, Plaikner, and Köhler).
| | - Hermann Hertel
- Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Germany (Dr. Hertel)
| | - Kati Hasenbein
- Specialized Medical Practice for Gynecologic Oncology, Berlin-Spandau, Berlin, Germany (Dr. Hasenbein)
| | - Anja Petzel
- Center for Dysplasia and Cytology, MVZ Kreuzberg, Berlin, Germany (Dr. Petzel)
| | - Melanie Schubert
- Department of Gynecology and Obstetrics, Schleswig-Holstein University Medicine, Campus Kiel, Germany (Dr. Schubert)
| | - Jens Uwe Blohmer
- Department of Gynecology, Charité University Medicine, Campus Mitte, Berlin, Germany (Dr. Blohmer)
| | - Gerd Böhmer
- Center for Dysplasia and Cytology, IZD Hannover, Hannover, Germany (Dr. Böhmer)
| | - Simone Marnitz
- Radiation Oncology Vosspalais, Private Clinic, Berlin, Germany (Dr. Marnitz)
| | - Volker Ragosch
- Department of Obstetrics (Dr. Ragosch), Asklepios Clinic Altona, Hamburg, Germany
| | - Christian Domröse
- Department of Gynecology, University of Cologne, Medical Faculty, Germany (Dr. Domröse)
| | - Peter Oppelt
- Department for Gynecology, Obstetrics and Gynecological Endocrinology, Johannes Kepler University Linz, Austria (Dr. Oppelt)
| | - Anne Jülicher
- Institute for Dysplasia and Cytology, MVZ Fürstenbergkarree Berlin, Germany (Drs. Jülicher, Schneider, and Köhler)
| | - Achim Schneider
- Institute for Dysplasia and Cytology, MVZ Fürstenbergkarree Berlin, Germany (Drs. Jülicher, Schneider, and Köhler)
| | - Anne Willems
- Institute for Dysplasia and Cytology, MVZ Köpenick, Germany (Dr. Willems)
| | - Giovanni Favero
- Department of Gynecology and Obstetrics, Asklepios Hospital Lich, Germany (Dr. Favero)
| | - Christhardt Köhler
- Department of Gynecology (Drs. Siegler, Plaikner, and Köhler); Institute for Dysplasia and Cytology, MVZ Fürstenbergkarree Berlin, Germany (Drs. Jülicher, Schneider, and Köhler); Department of Gynecology, German Red Cross Clinic Berlin Westend, Berlin, Germany (Dr. Köhler)
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4
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Plaikner A, Siegler K, Hertel H, Jacob A, Petzel A, Schubert M, Blohmer JU, Böhmer G, Marnitz S, Ragosch V, Domröse C, Oppelt P, Jülicher A, Schneider A, Willems A, Favero G, Köhler C. Fertility sparing therapy in women with lymph node negative cervical cancer >2cm - oncologic and fertility outcomes of neoadjuvant chemotherapy followed by radical vaginal trachelectomy. Int J Gynecol Cancer 2023; 33:1542-1547. [PMID: 37696645 DOI: 10.1136/ijgc-2023-004669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023] Open
Abstract
OBJECTIVE Simple or radical trachelectomy are accepted fertility sparing therapies for patients diagnosed with cervical cancer ≤2 cm. In patients with larger tumors a fertility sparing concept is considered experimental. The aim of our study is to present oncological and fertility outcomes of laparoscopic pelvic lymphadenectomy followed by neoadjuvant chemotherapy and subsequent radical vaginal trachelectomy. These procedures were performed in two centers in patients diagnosed with cervical cancer of diameter >2 cm. METHOD We retrospectively analyzed the demographic, histological, fertility and follow-up data of all patients with cervical cancer assessed as stage IB2, IB3 or IIA1 under the International Federation of Gynecology and Obstetrics (FIGO) 2018 system. These patients had undergone pelvic lymphadenectomy, followed by neoadjuvant chemotherapy and radical vaginal trachelectomy between February 2006 and June 2020 at Charité University Berlin and Asklepios Hospital, Hamburg. RESULTS A total of 31 patients (mean age 29.5 years, range; 26-40) underwent neoadjuvant chemotherapy followed by radical vaginal trachelectomy in case of proven tumor-free lymph nodes. Twenty-six (84%) of these patients were nulliparous. Across all 31 patients, the initial tumor stages were FIGO 2018 stage IB2 (n=27), IB3 (n=3) and IIA1 (n=1).Lymphadenectomy was completed in all but one patient (sentinel) with a median of 33 (range; 11-47) pelvic lymph nodes. The neoadjuvant chemotherapy regimen was two cycles of paclitaxel, ifosfamide and cisplatin in 17 patients; three cycles of paclitaxel, ifosfamide and cisplatin in eight patients; two cycles of paclitaxel and cisplatin in four patients; two cylces cisplatin monoagent in one patient; and two cycles of paclitaxel and cisplatin followed by two cycles of paclitaxel, ifosfamide and cisplatin in one patient. Residual tumor was histologically confirmed in 17 specimens (55%). The median residual tumor size following neoadjuvant chemotherapy was 12 mm (range; 1-60). Fertility could be preserved in 27 patients (87%); two patients underwent adjuvant chemoradiation after radical vaginal trachelectomy due to high-risk histological features; two other patients underwent radical hysterectomy with adjuvant chemoradiation therapy following neoadjuvant chemotherapy. Of 18 (67%) patients seeking motherhood, 13 became pregnant (72%). There were 12 live births in 10 women, with a median fetal weight of 2490 grams (range; 1640-3560) and five miscarriages. After a median follow-up of 94.5 months (range; 6-183) three recurrences (11.1%) were detected, one patient (3.7%) died of the disease. CONCLUSION Neoadjuvant chemotherapy followed by radical vaginal trachelectomy may be offered to patients seeking motherhood with cervical cancer >2 cm and histopathologically tumor-free lymph nodes, the rate of healthy baby pregnancy on discharge was 10/18 women (55%). This fertility-preserving strategy is associated with higher recurrence and death compared with what was published in the literature for women undergoing radical vaginal trachelectomy for tumors up to 2 cm.
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Affiliation(s)
- Andrea Plaikner
- Department of Special Operative and Oncologic Gynecology, Asklepios Klinik Altona, Hamburg, Hamburg, Germany
| | - Kathrin Siegler
- Department of Special Operative and Oncologic Gynecology, Asklepios Klinik Altona, Hamburg, Hamburg, Germany
| | - Hermann Hertel
- Department of Obstetrics and Gynecology, Hannover Medical School, Hannover, Niedersachsen, Germany
| | - Anna Jacob
- Department of Gynecology, Asklepios Clinic Wandsbek, Hamburg, Germany
| | - Anja Petzel
- Institute for Dysplasia and Cytology, MVZ Kreuzberg, Berlin, Germany
| | - Melanie Schubert
- Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Jens-Uwe Blohmer
- Charité University Medicine, Department of Gynecology, Charité, Campus Mitte, Berlin, Germany
| | - Gerd Böhmer
- Institute for Dysplasia and Cytology, IZD Hannover, Hannover, Germany
| | - Simone Marnitz
- Department of Radiooncology, Radiation Oncology Vosspalais, Private Clinic, Berlin, Germany, Berlin, Berlin, Germany
| | - Volker Ragosch
- Department of Obstetrics, Asklepios Clinic Altona, Hamburg, Germany
| | - Christian Domröse
- Department of Obstetrics and Gynecology, Medical Faculty of the University of Cologne, Köln, Nordrhein-Westfalen, Germany
| | - Peter Oppelt
- Department for Gynecology, Obstetrics and Gynecological Endocrinology, Johannes Kepler University Linz, Linz, Austria
| | - Anne Jülicher
- Institute for Dysplasia and Cytology, MVZ Fürstenbergkarree, Berlin, Germany
| | - Achim Schneider
- Institute for Dysplasia and Cytology, MVZ Fürstenbergkarree, Berlin, Germany
| | - Anne Willems
- Institute for Dysplasia and Cytology, MVZ Köpenick, Germany
| | - Giovanni Favero
- Department of Gynecology and Obstetrics, Asklepios Hospital Lich, Lich, Germany
| | - Christhardt Köhler
- Department of Special Operative and Oncologic Gynecology, Asklepios Klinik Altona, Hamburg, Hamburg, Germany
- Institute for Dysplasia and Cytology, MVZ Fürstenbergkarree, Berlin, Germany
- Department of Gynecology, German Red Cross Clinic Berlin Westend, Berlin, Germany
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5
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Wang Y, Chen Y, Wang M, Qin Z, Zhang L, Zheng A, Han L. Oncological and reproductive outcomes of conization combined with pelvic node evaluation in patients with early-stage cervical cancer: a systematic review and meta-analysis. Front Oncol 2023; 13:1251453. [PMID: 37795440 PMCID: PMC10546176 DOI: 10.3389/fonc.2023.1251453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 08/30/2023] [Indexed: 10/06/2023] Open
Abstract
Objective This study aims to preliminarily assess the oncological and reproductive outcomes of fertility preservation treatment using conization combined with pelvic node evaluation in young patients with early-stage cervical cancer (ECC) through meta-analysis. Methods In this meta-analysis, we analyzed studies published in PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), International Clinical Trials Registry Platform (ICTRP), and Clinical Trials. gov that appeared in our search from inception to 0 7/02/2023. Results There were 17 relevant studies with a total of 620 patients included, of which 444 patients received conization combined with pelvic node evaluation. The combined pregnancy rate was 45.4% (95% CI: 0.34-0.57), the combined live birth rate was 33.9% (95% CI: 0.26-0.42), the combined miscarriage rate was 4.8% (95% CI: 0.02-0.092), the combined preterm delivery rate was 5.1% (95% CI: 0.02-0.092), and the combined recurrence rate was 1.9% (95% CI: 0.006-0.035), which did not significantly differ from that of patients who received radical surgery (OR: 0.689, 95% CI: 0.506-0.938). Conclusion Cervical conization combined with pelvic lymph node evaluation for fertility preservation in young ECC patients can achieve oncological outcomes similar to radical surgery while improving pregnancy success rates and preserving postoperative fertility. In summary, fertility preservation treatment using cervical conization combined with pelvic lymph node evaluation may be considered as a viable option for young ECC patients with strong fertility preservation desire, resulting in better pregnancy and live birth outcomes. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/#myprospero, identifier PROSPERO (CRD42023423432).
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Affiliation(s)
- Yisi Wang
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Yali Chen
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Mengyao Wang
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Zhaojuan Qin
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Lingli Zhang
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Ai Zheng
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Ling Han
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
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6
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Ronsini C, Solazzo MC, Molitierno R, De Franciscis P, Pasanisi F, Cobellis L, Colacurci N. Fertility-Sparing Treatment for Early-Stage Cervical Cancer ≥ 2 cm: Can One Still Effectively Become a Mother? A Systematic Review of Fertility Outcomes. Ann Surg Oncol 2023; 30:5587-5596. [PMID: 37261562 PMCID: PMC10409841 DOI: 10.1245/s10434-023-13542-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 04/09/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND Fertility-sparing treatments (FSTs) have played a crucial role in the management of early-stage cervical cancer (ECC); however, there is currently no standard of care for women with ECC ≥ 2 cm who wish to preserve their fertility. The current orientation of the scientific community comprises upfront surgical techniques and neoadjuvant chemotherapy (NACT) followed by minor surgery such us conization. However these approaches are not standardized. This systematic review aimed to collect the evidence in the literature regarding the obstetric outcomes of the different techniques for applying FSTs in ECC ≥ 2 cm. METHODS A systematic review was performed in September 2022 using the Pubmed and Scopus databases, from the date of the first publication. We included all studies containing data regarding pregnancy, birth, and preterm rates. RESULTS Fifteen studies fulfilled the inclusion criteria, and 352 patients were analyzed regarding fertility outcomes. Surgery-based FST showed the pregnancy rate (22%), birth rate (11%), and preterm rate (10%). Papers regarding FST using the NACT approach showed a pregnancy rate of 44%, with a birth rate of 45% in patients who managed to get pregnant. The preterm rate amounted to 44%, and pregnancy rates and birth rates were significantly different between the two groups (p < 0.001). CONCLUSION Fertility preservation in patients with ECC > 2 cm is challenging. The endpoint for evaluating the best treatment should include oncological and fertility outcomes together. From this prospective, NACT followed by less radical surgery could be a reasonable compromise.
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Affiliation(s)
- Carlo Ronsini
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy.
| | - M C Solazzo
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - R Molitierno
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - P De Franciscis
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - F Pasanisi
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - L Cobellis
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - N Colacurci
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Naples, Italy
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7
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Robova H, Rob L, Halaska MJ, Drozenova J, Pichlik T, Drochytek V, Hruda M. Twenty years of experience with less radical fertility-sparing surgery in early-stage cervical cancer: Pregnancy outcomes. Gynecol Oncol 2023; 174:76-79. [PMID: 37163776 DOI: 10.1016/j.ygyno.2023.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 04/04/2023] [Accepted: 04/17/2023] [Indexed: 05/12/2023]
Abstract
INTRODUCTION The standard procedure in cervical cancer is radical hysterectomy and pelvic lymphadenectomy (PLND). Because of the increasing age of women bearing children, fertility has become a major challenge. We present pregnancy results after less radical fertility-sparing surgery in women with IA1, LVSI positive, IA2 and IB1 (<2 cm, infiltration less than half of the cervical stroma). MATERIALS AND METHOD All women (n = 91) underwent laparoscopic sentinel lymph node mapping with frozen section followed by PLND and "selective parametrectomy" (removal of afferent lymphatic channels from the paracervix) if sentinel nodes (SLN) are negative. If lymph nodes were verified negative by definitive histopathology, patients were treated by simple trachelectomy (IB1) or large cone (IA1/IA2) biopsy 1 week after primary surgery. RESULTS From 1999 to 2018, 91 women were enrolled in the study (median age 29.1 years, range 21-40). Fertility was spared in 76 (83.5%) women; 13 (17.1%) women did not plan future pregnancy and 63 (82.9%) had pregnancy desires. Fifty-four of 63 women conceived (pregnancy rate 85.7%) and 48 of 63 delivered 58 babies (delivery rate 76.2%). Thirty-nine women delivered in term (67.2%): 13 women between 32 and 36 + 6 weeks of pregnancy, 3 between 28 and 31 + 6 weeks and 3 between 24 and 27 + 6 weeks. Only one woman still plans pregnancy. One woman is currently pregnant. CONCLUSION The goal of fertility-sparing surgery is to produce good oncological results and promising pregnancy outcomes. Pregnancy results after less radical fertility-sparing procedures show promise (pregnancy rate 82.9% and delivery rate 76.2%).
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Affiliation(s)
- Helena Robova
- 3(rd) Medical Faculty, Charles University in Prague, Department of Obstetrics & Gynaecology, Czech Republic
| | - Lukas Rob
- 3(rd) Medical Faculty, Charles University in Prague, Department of Obstetrics & Gynaecology, Czech Republic.
| | - Michael J Halaska
- 3(rd) Medical Faculty, Charles University in Prague, Department of Obstetrics & Gynaecology, Czech Republic
| | - Jana Drozenova
- 3(rd) Medical Faculty, Charles University, Department of Pathology, Czech Republic
| | - Tomas Pichlik
- 3(rd) Medical Faculty, Charles University in Prague, Department of Obstetrics & Gynaecology, Czech Republic
| | - Vit Drochytek
- 3(rd) Medical Faculty, Charles University in Prague, Department of Obstetrics & Gynaecology, Czech Republic
| | - Martin Hruda
- 3(rd) Medical Faculty, Charles University in Prague, Department of Obstetrics & Gynaecology, Czech Republic; Faculty of Medicine in Plzeň, Charles University, Department of Obstetrics & Gynaecology, Czech Republic
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8
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Pak T, Sadowski E, Patel-Lippmann K. MR Imaging in Cervical Cancer. Radiol Clin North Am 2023; 61:639-649. [PMID: 37169429 DOI: 10.1016/j.rcl.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
Cervical cancer remains a significant contributor to morbidity and mortality for women globally despite medical advances in preventative medicine and treatment. The 2018 Internal Federation of Gynecology and Obstetrics committee modified their original 2009 staging scheme to incorporate advanced imaging modalities, where available, to increase the accuracy of staging and to guide evolving treatments. Having a robust understanding of the newest staging iteration, its consequences on treatment pathways, and common imaging pitfalls will aid the radiologist in generating valuable and practical reports to optimize treatment strategies.
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9
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Chen T, Li J, Zhu Y, Lu AW, Zhou L, Wang JS, Zhang Y, Wang JT. The oncological and obstetric results of radical trachelectomy as a fertility-sparing therapy in early-stage cervical cancer patients. BMC Womens Health 2022; 22:424. [PMID: 36289488 PMCID: PMC9608899 DOI: 10.1186/s12905-022-01990-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 09/19/2022] [Indexed: 11/06/2022] Open
Abstract
Purpose This study explored the oncological and obstetric results of radical trachelectomy (RT) in early-stage cervical cancer patients. Methods A retrospective analysis was conducted the oncological and obstetric results of 23 patients with early cervical cancer (stages IA2–IB3; International Federation of Gynecology and Obstetrics, 2018) who underwent RT in The Maternal and Child Health Care Hospital of Guiyang, China, from October 2004 to September 2018. Results 23 patients had cervical tumors of the squamous cell carcinoma histological type. All 23 patients retained reproductive function. The mean follow-up time was 112.87 ± 55.75 (36–199) months. The median tumor size was 2.00 ± 1.35 cm (imperceptible to the eyes 5.00 cm). No recurrence was observed in any of the patient cases. Among the patients with a tumor size > 4 cm (up to 5 cm), three patients who wished to preserve fertility accepted RT following neoadjuvant chemotherapy The pregnancy outcomes were as follows: 8 cases (47.06%) out of 17 cases who attempting pregnancy conceived 12 times.First-trimester abortion and the voluntary abandonment of pregnancy occurred in 4 cases (33.33%), respectively, one patient performed deliberate termination at 24 weeks of gestation. Second-trimester abortion occurred in three cases (25.0%) for chorioamnionitis. Premature delivery at 32 weeks occurred in one case (8.33%). Conclusion Radical trachelectomy is a safe and effective treatment for women with early-stage cervical cancer preserving fertility biology. Patients with a cervical tumor sized > 4 cm can be pregnant after neoadjuvant chemotherapy and RT. Accordingly, this treatment is worthy of further exploration.
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Affiliation(s)
- Tao Chen
- Department of Gynecology, Maternal and Child Health Care Hospital of Guiyang, NO.63 Ruijin South Road, 561000 Guiyang, Guizhou China
| | - Jia Li
- Department of Gynecology, Maternal and Child Health Care Hospital of Guiyang, NO.63 Ruijin South Road, 561000 Guiyang, Guizhou China
| | - Yan Zhu
- Department of Gynecology, Maternal and Child Health Care Hospital of Guiyang, NO.63 Ruijin South Road, 561000 Guiyang, Guizhou China
| | - An-Wei Lu
- grid.284723.80000 0000 8877 7471Department of Gynecology, Shenzhen Hospital Affiliated to Southern Medical University, NO.1333 Xinhu Road, 518000 Shenzhen, China
| | - Li Zhou
- grid.284723.80000 0000 8877 7471Department of Gynecology, Shenzhen Hospital Affiliated to Southern Medical University, NO.1333 Xinhu Road, 518000 Shenzhen, China
| | - Jian-San Wang
- Department of Gynecology, Maternal and Child Health Care Hospital of Guiyang, NO.63 Ruijin South Road, 561000 Guiyang, Guizhou China
| | - Ying Zhang
- Department of Reproductive Center, Maternal and Child Health Care Hospital of Guiyang, NO.63 Ruijin South Road, 561000 Guiyang, Guizhou China
| | - Jun-Tao Wang
- Department of Gynecology, Maternal and Child Health Care Hospital of Guiyang, NO.63 Ruijin South Road, 561000 Guiyang, Guizhou China
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Baiocchi G, Tsunoda AT, Guitmann G, Vieira MA, Zanvettor PH, Silvestre JBCH, Santos MH, Sacramento RDMM, de Araujo EO, Lopes RH, Falcao D, Lopes A, Schmidt R, Lyra JS, Almeida HIB, Casteleins WA, Cintra GF, Zanini LAG, Reis RJ, Coelho EG, Fin FR, Rezende V, Pançan TDM, Vieira SC, Silva JS, de Andrade MR, Carneiro VCG, Foiato TF, Ritt GF, Ianaze GC, Moretti‐Marques R, Andrade CEMC, Maciel LF, Lira DL, Medeiros GM, Leite ALS, Cucolicchio GO, Tayeh MRA, Cruz RP, Guth GZ, Leal RMLV, Magno VA, Lopes FCO, Laporte GA, Pupo‐Nogueira A, Barros AV, da Cunha JR, Pessini SA, Braganca JF, Figueiredo HF, Loureiro CMB, Bocanegra RED, Affonso RJ, Fernandes PHDS, Ribeiro HSC, Batista TP, Oliveira AF, Ribeiro R. Brazilian Society of Surgical Oncology consensus on fertility‐sparing surgery for cervical cancer. J Surg Oncol 2022; 126:37-47. [DOI: 10.1002/jso.26899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 03/13/2022] [Indexed: 01/27/2023]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Andre Lopes
- Sao Paulo State Institute of Cancer Sao Paulo Brazil
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11
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Does radical trachelectomy (RT) during pregnancy have higher obstetrical and oncological risks than RT before pregnancy? Arch Gynecol Obstet 2022; 306:189-197. [PMID: 35235022 DOI: 10.1007/s00404-021-06327-w] [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: 01/23/2021] [Accepted: 11/05/2021] [Indexed: 11/02/2022]
Abstract
PURPOSE Radical trachelectomy (RT) with pelvic lymphadenectomy has become a new treatment option for young patients with uterine cervical cancer stages 1A2-1B1 who desire the preservation of their fertility. However, the application of RT for pregnant patients is still controversial. We comparatively studied both obstetrical and oncological outcomes of pregnant patients who underwent vaginal RT during pregnancy and those who underwent vaginal RT before pregnancy. METHODS Both obstetrical and oncological results of eight patients who underwent vaginal RT with pelvic lymphadenectomy during pregnancy in our institute between 2010 and 2020 (Group A), and ten pregnant patients who underwent vaginal RT with pelvic lymphadenectomy before pregnancy during the same period (Group B) were reviewed based on their medical charts. RESULTS There were neither significant differences in blood loss, surgical time, or surgical completeness between Group A and Group B, nor were there significant differences in obstetrical outcomes between the two groups. However, two of the eight patients in Group A had recurrence of the cancer. None of the patients in Group B has shown any signs of recurrence thus far. CONCLUSION Vaginal RT during pregnancy does not affect the obstetrical prognoses of patients with early invasive uterine cervical cancer, and it might be a tolerable treatment modality for them. However, oncologically, it should be performed carefully as there is a risk of recurrence.
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12
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Ghosh S, Jayaram P, Kabekkodu SP, Satyamoorthy K. Targeted drug delivery in cervical cancer: Current perspectives. Eur J Pharmacol 2022; 917:174751. [PMID: 35021110 DOI: 10.1016/j.ejphar.2022.174751] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/29/2021] [Accepted: 01/05/2022] [Indexed: 02/06/2023]
Abstract
Cervical cancer is preventable yet one of the most prevalent cancers among women around the globe. Though regular screening has resulted in the decline in incidence, the disease claims a high number of lives every year, especially in the developing countries. Owing to rather aggressive and non-specific nature of the conventional chemotherapeutics, there is a growing need for newer treatment modalities. The advent of nanotechnology has assisted in this through the use of nanocarriers for targeted drug delivery. A number of nanocarriers are continuously being developed and studied for their application in drug delivery. The present review summarises the different drug delivery approaches and nanocarriers that can be useful, their advantages and limitation.
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Affiliation(s)
- Supriti Ghosh
- Department of Cell and Molecular Biology, Manipal School of Life Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Pradyumna Jayaram
- Department of Cell and Molecular Biology, Manipal School of Life Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Shama Prasada Kabekkodu
- Department of Cell and Molecular Biology, Manipal School of Life Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India
| | - Kapaettu Satyamoorthy
- Department of Cell and Molecular Biology, Manipal School of Life Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, 576104, India.
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13
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Guimarães YM, Godoy LR, Longatto-Filho A, dos Reis R. Management of Early-Stage Cervical Cancer: A Literature Review. Cancers (Basel) 2022; 14:cancers14030575. [PMID: 35158843 PMCID: PMC8833411 DOI: 10.3390/cancers14030575] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 12/17/2021] [Indexed: 12/24/2022] Open
Abstract
Simple Summary Despite being a preventable disease, cervical cancer still causes morbidity and deaths worldwide. In the early stages (FIGO IA1 with lymph-vascular space invasion-IIA1), the disease is highly curable. The primary treatment for early-stage cervical cancer is radical hysterectomy with pelvic lymphadenectomy. This surgical treatment has changed during the past decades, and we aimed to review and discuss the advances in the literature. We performed a literature review through PubMed focusing on English articles about the topic of surgical management of early-stage cervical cancer. The emergent topics considered here are the FIGO 2018 staging system update, conservative management for selected patients, sentinel lymph node mapping, fertility preservation, surgical approach, and management of tumors up to 2 cm. These topics show an evolvement to a more tailored treatment to prevent morbidity and assure oncologic safety. Abstract Cervical cancer (CC) remains a public health issue worldwide despite preventive measures. Surgical treatment in the early-stage CC has evolved during the last decades. Our aim was to review the advances in the literature and summarize the ongoing studies on this topic. To this end, we conducted a literature review through PubMed focusing on English-language articles on the surgical management of early-stage CC. The emergent topics considered here are the FIGO 2018 staging system update, conservative management with less radical procedures for selected patients, lymph node staging, fertility preservation, preferred surgical approach, management of tumors up to 2 cm, and prognosis. In terms of updating FIGO, we highlight the inclusion of lymph node status on staging and the possibility of imaging. Regarding the preferred surgical approach, we emphasize the LACC trial impact worldwide in favor of open surgery; however, we discuss the controversial application of this for tumors < 2 cm. In summary, all topics show a tendency to provide patients with tailored treatment that avoids morbidity while maintaining oncologic safety, which is already possible in high-income countries. We believe that efforts should focus on making this a reality for low-income countries as well.
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Affiliation(s)
- Yasmin Medeiros Guimarães
- Molecular Oncology Research Center, Barretos Cancer Hospital, São Paulo 14784-400, Brazil; (Y.M.G.); (L.R.G.); (A.L.-F.)
| | - Luani Rezende Godoy
- Molecular Oncology Research Center, Barretos Cancer Hospital, São Paulo 14784-400, Brazil; (Y.M.G.); (L.R.G.); (A.L.-F.)
| | - Adhemar Longatto-Filho
- Molecular Oncology Research Center, Barretos Cancer Hospital, São Paulo 14784-400, Brazil; (Y.M.G.); (L.R.G.); (A.L.-F.)
- Medical Laboratory of Medical Investigation (LIM) 14, Department of Pathology, Medical School, University of São Paulo, São Paulo 01246-903, Brazil
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal
- ICVS/3B’s—PT Government Associate Laboratory, 4710-057 Braga, Portugal
- ICVS/3B’s—PT Government Associate Laboratory, 4805-017 Guimarães, Portugal
| | - Ricardo dos Reis
- Department of Gynecologic Oncology, Barretos Cancer Hospital, São Paulo 14784-400, Brazil
- Correspondence: ; Tel.: +55-17-3321-6600 (ext. 7126)
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14
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Mandić A, Gutić B, Davidović-Grigoraki M, Petrović Đ, Šolajić N, Nađ GS. Simple trachelectomy following neoadjuvant chemotherapy in cervical cancer over 2 cm in size: A case report and review of literature. SCRIPTA MEDICA 2022. [DOI: 10.5937/scriptamed53-39686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
In the past few decades fertility preservation has emerged as a treatment modality for cervical cancer patients. Different surgical methods have been described, such as open or minimally invasive trachelectomy and gross cervical conisation combined with laparoscopic lymphadenectomy. A thirty-year-old nulliparous woman with uterine cervical cancer FIGO stage IB2 (classification from 2009) underwent neoadjuvant chemotherapy. After three cycles of chemotherapy with cisplatin and iphosphamide there was no colposcopic findings of cervical invasion, therefore a conservative surgery was performed. The patient underwent laparoscopic pelvic lymphadenectomy, cervical amputation and the endocervical curettage. The histopathology confirmed a complete response to chemotherapy.
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15
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Castle PE, Einstein MH, Sahasrabuddhe VV. Cervical cancer prevention and control in women living with human immunodeficiency virus. CA Cancer J Clin 2021; 71:505-526. [PMID: 34499351 PMCID: PMC10054840 DOI: 10.3322/caac.21696] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 08/07/2021] [Accepted: 08/10/2021] [Indexed: 12/16/2022] Open
Abstract
Despite being highly preventable, cervical cancer is the fourth most common cancer and cause of cancer death in women globally. In low-income countries, cervical cancer is often the leading cause of cancer-related morbidity and mortality. Women living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome are at a particularly high risk of cervical cancer because of an impaired immune response to human papillomavirus, the obligate cause of virtually all cervical cancers. Globally, approximately 1 in 20 cervical cancers is attributable to HIV; in sub-Saharan Africa, approximately 1 in 5 cervical cancers is due to HIV. Here, the authors provide a critical appraisal of the evidence to date on the impact of HIV disease on cervical cancer risk, describe key methodologic issues, and frame the key outstanding research questions, especially as they apply to ongoing global efforts for prevention and control of cervical cancer. Expanded efforts to integrate HIV care with cervical cancer prevention and control, and vice versa, could assist the global effort to eliminate cervical cancer as a public health problem.
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Affiliation(s)
- Philip E Castle
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Rockville, Maryland
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, Maryland
| | - Mark H Einstein
- Department of Obstetrics, Gynecology, and Reproductive Health, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Vikrant V Sahasrabuddhe
- Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Rockville, Maryland
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Fertility Sparing Treatment in Gastric-Type Endocervical Carcinoma. Cancers (Basel) 2021; 13:cancers13205177. [PMID: 34680326 PMCID: PMC8533748 DOI: 10.3390/cancers13205177] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 10/09/2021] [Accepted: 10/12/2021] [Indexed: 02/06/2023] Open
Abstract
Simple Summary Due to a trend toward late childbearing, fertility preservation has become a major issue in young patients with gynecological cancer. Surgical fertility sparing management is universally acknowledged as an acceptable option in eligible patients with cervical cancer. Excisional cone biopsy or trachelectomy are now standard surgical procedures offered to selected patients with gynecological malignancies who wish to preserve their fertility. Neoadjuvant chemotherapy followed by surgery is another therapeutic option studied currently in numerous clinical trials. However, fertility preserving treatment is generally not recommended in rare histological types of cervical cancer, including clinically aggressive gastric-type endocervical carcinoma. Due to controversies in this emerging topic, a review of literature and international database was carried out, in search of solid evidence on fertility sparing management in gastric-type endocervical carcinoma. Abstract Fertility sparing management of cancer is one of the main components of quality-of-life issues. Early-stage cervical cancer, frequently diagnosed in women of reproductive age, can potentially be treated conservatively. However, some rare histological types of cervical cancer present with aggressive clinical behavior. Particularly, in the newly introduced concept of gastric-type endocervical carcinoma, fertility sparing management is ‘a priori’ not recommended. Even so, this issue remains undocumented. For this reason, a selected review of the current literature on gastric type endocervical carcinoma was carried out through PubMed. The keywords included “gastric-type cervical cancer”, “gastric-type endocervical carcinoma”, “conservative surgery”, “conservative treatment”, “fertility sparing surgery”, “radical trachelectomy”, “laparoscopic trachelectomy”, “robotic trachelectomy”, “laparotomic trachelectomy”, “abdominal trachelectomy”, “trachelectomy”, “neoadjuvant chemotherapy”, “conisation”, and “cone resection”. A search in the European Network on Cancer, Infertility and Pregnancy (INCIP) database was performed. The rarity of gastric-type endocervical carcinoma does not allow for conclusions on fertility sparing management with solid evidence. However, diffuse character of the disease and aggressive clinical behavior contraindicate a conservative treatment in young women with gastric type cervical cancer.
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Neoadjuvant chemotherapy followed by fertility sparing surgery in cervical cancers size 2-4 cm; emerging data and future perspectives. Gynecol Oncol 2021; 162:809-815. [PMID: 34130862 DOI: 10.1016/j.ygyno.2021.06.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 06/07/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Approach to the management of early stage cervical cancers with tumor size >2 cm in women who desire fertility preservation has been fraught with controversy. Fertility sparing surgery for FIGO 2018 stage IB cancers has been validated most for tumors ≤2 cm. In this review, our objective was to evaluate the oncologic and obstetric outcomes for women that underwent neoadjuvant chemotherapy (NACT) before fertility sparing surgery for tumors 2-4 cm. METHODS We performed a systematic literature review and searched PubMed, Google Scholar, Cochrane Reviews and UpToDate (from January 2000 to February 2021) using the terms: cervical cancer, fertility preservation, trachelectomy, radical trachelectomy, neoadjuvant chemotherapy, cervical cancer treatment, stage IB1 or IB2 cervical cancer, and cervical cancer size 2-4 cm. We included manuscripts with information on patients with tumor sizes 2-4 cm, lymph node status, follow-up, obstetric and oncologic outcome. We excluded review articles or articles without all pertinent patient information. RESULTS Eighteen articles were identified including 249 patients. For final analysis, 114 met inclusion criteria. All included patients had FIGO 2018 stage IB2 cervical cancer, underwent neoadjuvant chemotherapy and subsequent fertility sparing surgery. Vaginal radical trachelectomy, cold knife conization, abdominal radical trachelectomy, laparoscopic radical trachelectomy, simple vaginal trachelectomy, and cone laser were performed in 46 (40.4%), 26 (22.8%), 14 (12.3%), 13 (11.4%), 8 (7%), and 7 (6.1%) women, respectively. The most common regimen of chemotherapy was platinum-based therapy with cisplatin. The follow-up time reported in all studies ranged from 1 to 225 months. Of 64 attempted pregnancies, there were 49 (76.6%) viable deliveries which included 6 preterm births (9.4%). The recurrence rate was 6.1% and two patients (1.8%) died of disease. CONCLUSION Fertility sparing surgery following NACT is an option for women with cervical cancers that are 2-4 cm that wish to preserve fertility without sacrificing oncologic or obstetric outcomes. Confirmation of these findings are anticipated from an ongoing international phase II clinical trial [1].
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Kiss SL, Fandi A, Cozlea AL, Gheorghe M, Stanca M, Bacalbașa N, Moldovan AA, Căpîlna ME. Abdominal radical trachelectomy as fertility-sparing management for early stages of cervical cancer: Our experience in 18 cases. Exp Ther Med 2021; 22:674. [PMID: 33986839 PMCID: PMC8111865 DOI: 10.3892/etm.2021.10106] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 03/18/2021] [Indexed: 11/05/2022] Open
Abstract
The aim of this study was to present our experience of 18 cases of abdominal radical trachelectomy (ART), including 5 performed during pregnancy, analyzing patient selection, surgical complications, and oncological and obstetrical outcomes. This reproductive study included all early stage cervical cancer patients referred for ART at the 1st Obstetrics and Gynecology Clinic of the Emergency Clinical County Hospital Targu Mures, between 2010 and 2020. A total of 19 women were considered for ART, and only 1 case required conversion to radical hysterectomy. The patient mean age was 31 years (range 24-38 years), and 66.67% of the patients were nulliparous. Six women (33.33%) had stage IA2, 4 (22.22%) had stage IB1, 5 (27.78%) had stage IB2, and 4 (22.22%) had stage IB3 disease. One intraoperative complication occurred in this series, which consisted in both right ureteral and bladder injuries. Early postoperative complications were represented by urinary bladder dysfunction (33.33%), symptomatic pelvic lymphocele (11.1%), peritonitis (5.5%), and wound infection (5.5%). Late postoperative complications included cervical stenosis (5.5%), amenorrhea (11.1%), and pelvic abscess (5.5%). Four out of the 18 patients were operated on during pregnancy between 14 and 20 weeks; 2 of them gave birth at term, 2 of them aborted shortly after the surgery. Two vaginal recurrences were recorded; both were managed by hysterectomy, partial colpectomy and adjuvant chemoradiotherapy. At this moment, all patients are alive with no evidence of disease and 3 of them managed to conceive. In conclusion, ART should be recommended as a fertility-preserving procedure for women in their reproductive age. In selected cases, ART can be performed during pregnancy with encouraging results.
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Affiliation(s)
- Szilard Leo Kiss
- First Obstetrics and Gynecology Clinic, 'George Emil Palade' University of Medicine, Pharmacy, Science and Technology, 540136 Târgu Mures, Romania
| | - Anas Fandi
- First Obstetrics and Gynecology Clinic, 'George Emil Palade' University of Medicine, Pharmacy, Science and Technology, 540136 Târgu Mures, Romania
| | - Alexandra Lavinia Cozlea
- First Obstetrics and Gynecology Clinic, 'George Emil Palade' University of Medicine, Pharmacy, Science and Technology, 540136 Târgu Mures, Romania
| | - Mihai Gheorghe
- First Obstetrics and Gynecology Clinic, 'George Emil Palade' University of Medicine, Pharmacy, Science and Technology, 540136 Târgu Mures, Romania
| | - Mihai Stanca
- First Obstetrics and Gynecology Clinic, 'George Emil Palade' University of Medicine, Pharmacy, Science and Technology, 540136 Târgu Mures, Romania
| | - Nicolae Bacalbașa
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 020022 Bucharest, Romania
| | | | - Mihai Emil Căpîlna
- First Obstetrics and Gynecology Clinic, 'George Emil Palade' University of Medicine, Pharmacy, Science and Technology, 540136 Târgu Mures, Romania
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Martinelli F, Ditto A, Filippi F, Vinti D, Bogani G, Leone Roberti Maggiore U, Evangelista M, Signorelli M, Chiappa V, Lopez S, Somigliana E, Raspagliesi F. Conization and lymph node evaluation as a fertility-sparing treatment for early stage cervical cancer. Int J Gynecol Cancer 2021; 31:457-461. [PMID: 33649014 DOI: 10.1136/ijgc-2020-001740] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 12/08/2020] [Accepted: 12/10/2020] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION To evaluate oncological and obstetrical outcomes of early stage cervical cancer patients who underwent conservative management to retain childbearing potential. METHODS Data of women (aged <40 years) who underwent fertility sparing treatment for International Federation of Gynecology and Obstetrics (FIGO) stage IA1 with lymphovascular invasion (LVSI) and IB1 cervical cancer were prospectively collected. All patients underwent cervical conization/s and laparoscopic nodal evaluation (pelvic lymphadenectomy/sentinel node mapping). Oncological and obstetrical outcomes were assessed. RESULTS Overall, 39 patients met inclusion criteria; 36 (92.3%) women were nulliparous. There were: 3 (7.7%) IA1-LVSI+; 11 (28.2%) IA2; and 25 (64.1%) IB1 cervical cancers, according to 2018 FIGO stage classification. Histological types were 22 (56.4%) squamous carcinoma and 17 (43.6%) adenocarcinoma. Pelvic lymphadenectomy was performed in 29 (74.4%) patients, while 10 (25.6%) patients had only sentinel node mapping. In 4 (10.3%) patients conservative treatment was discontinued due to nodal involvement and 2 (5.1%) patients requested definitive treatment (hysterectomy) after a negative lymph node evaluation. Among 33 (84.6%) patients who retained their childbearing potential, 17 (51.5%) had a second conization. 2 (6.1%) patients relapsed and underwent definitive treatment. After a median follow-up of 51 months (range 1-184) no deaths were reported. 22 (70.9%) patients attempted to conceive. There were 13 natural pregnancies among 12 (54.5%) women who got pregnant. Live birth rate was 76.9%: 9 (69.2%) term and 1 (7.7%) preterm (at 32 weeks) deliveries. 2 (15.4%) miscarriages (first and second trimester) and 1 (7.7%) termination of pregnancy for medical reasons were recorded. CONCLUSION Conization plus laparoscopic nodal evaluation may be a safe and feasible conservative option in the setting of fertility-sparing treatment for early-stage cervical cancer patients.
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Affiliation(s)
- Fabio Martinelli
- Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Antonino Ditto
- Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Francesca Filippi
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Lombardia, Italy
| | - Daniele Vinti
- Obstetrics and Gynecology, ASST Rhodense, Garbagnate Milanese, Italy
| | - Giorgio Bogani
- Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | | | | | - Mauro Signorelli
- Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Valentina Chiappa
- Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Salvatore Lopez
- Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Edgardo Somigliana
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Lombardia, Italy.,Università degli Studi di Milano, Milan, Italy
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Burbano J, Heredia F, Sanabria D, Ardila EG, Viveros-Carreño D, Rodriguez J. Neoadjuvant chemotherapy prior to fertility-sparing surgery in cervical tumors larger than 2 cm: a systematic review on fertility and oncologic outcomes. Int J Gynecol Cancer 2021; 31:387-398. [PMID: 33649006 DOI: 10.1136/ijgc-2020-001765] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 01/11/2021] [Accepted: 01/13/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Management of cervical cancer tumors >2 cm has been a subject of controversy, with management often considered as either up-front radical trachelectomy or neoadjuvant chemotherapy before fertility-sparing surgery. METHODS A systematic literature review was conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) checklist. This study was registered in the International Prospective Register of Systematic Reviews (PROSPERO). We searched Medline through PubMed, EMBASE, Cochrane Central Register of Controlled Trials, SCOPUS, and OVID between January 1985 and December 2020. Eligibility criteria for selecting studies were English language, randomized controlled trials, and observational studies including information on fertility and oncologic outcomes. All titles were managed in EndNote X7. Risk of bias was evaluated using the Joanna Briggs Institute (JBI) critical appraisal checklist for observational studies. RESULTS Twenty-three studies with 205 patients who received neoadjuvant chemotherapy were included. The majority of patients (92.2%, n=189) had stage IB FIGO 2009 cervical cancer. The preferred regimen used was cisplatin in combination with paclitaxel or ifosfamide (80%, n=164). One hundred and eighty patients (87.8%) underwent fertility-sparing surgery; radical vaginal trachelectomy, abdominal trachelectomy, conization, and simple trachelectomy were performed in 62 (34.4%), 49 (27.2%), 34 (18.9%), and 26 (14.4%) women, respectively. In nine patients (5%) the type of procedure was not specified. The follow-up time reported in all studies ranged between 6 and 69 months. In 112 women who sought a pregnancy after surgery, 84.8% (n=95) achieved a gestation.The global recurrence and death rates were 12.8% and 2.8%, respectively. CONCLUSION Neoadjuvant chemotherapy followed by fertility-sparing surgery is a promising strategy that might allow fertility preservation in highly selected patients with cervical cancer with tumors >2 cm while providing acceptable oncologic outcomes. Results of prospective studies are required to validate its oncological safety. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42020203789.
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Affiliation(s)
- Javier Burbano
- Department of Gynecologic Oncology, Fundacion Clinica Valle del Lili, Cali, Colombia
| | - Fernando Heredia
- Department of Gynecology and Obstetrics, School of Medicine, Universidad de Concepción, Concepción, Chile
| | - Daniel Sanabria
- Department of Gynecologic Oncology, Clínica Los Nogales, Bogota, Colombia.,Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Bogota, Colombia
| | | | - David Viveros-Carreño
- Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Bogota, Colombia
| | - Juliana Rodriguez
- Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Bogota, Colombia .,Department of Gynecology and Obstetrics, Section of Gynecologic Oncology, Fundación Santa Fe de Bogota, Bogota, Colombia
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21
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Kasius JC, van der Velden J, Denswil NP, Tromp JM, Mom CH. Neo-adjuvant chemotherapy in fertility-sparing cervical cancer treatment. Best Pract Res Clin Obstet Gynaecol 2021; 75:82-100. [PMID: 33752979 DOI: 10.1016/j.bpobgyn.2021.01.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 01/31/2021] [Indexed: 12/20/2022]
Abstract
The current review provides a literature overview of studies assessing the oncological and fertility outcomes of treatment with neo-adjuvant chemotherapy followed by fertility-sparing surgery in patients with cervical cancer >2 cm. Six cohort studies were included showing severe heterogeneity regarding patient selection, chemotherapy regimen, and surgical approach. In total, 111 patients were studied, with overall favorable characteristics. Patients were on average 29 years old, had a tumor of 36 mm, no lymph node metastasis, and response to chemotherapy. In approximately 5-year follow-up, the recurrence rate was 13% (0%-21%) and overall death rate 2.7% (0%-10%). Three patients were alive with recurrent disease (2.7% and 0%-11%). Of the 111 patients, 90 underwent successful fertility-sparing treatment (83%). Roughly one-third conceived and one-fourth had a healthy live-born child. More research is essential to determine proper selection criteria for fertility-sparing treatment of cervical cancer >2 cm and the optimal treatment management.
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Affiliation(s)
- Jenneke C Kasius
- Gynecologic Oncology, Amsterdam University Medical Centre, Amsterdam, Centre for Gynecologic Oncology, Amsterdam, the Netherlands.
| | - Jacobus van der Velden
- Gynecologic Oncology, Amsterdam University Medical Centre, Amsterdam, Centre for Gynecologic Oncology, Amsterdam, the Netherlands
| | | | - Jacqueline M Tromp
- Gynecologic Oncology, Amsterdam University Medical Centre, Amsterdam, Centre for Gynecologic Oncology, Amsterdam, the Netherlands
| | - Constantijne H Mom
- Gynecologic Oncology, Amsterdam University Medical Centre, Amsterdam, Centre for Gynecologic Oncology, Amsterdam, the Netherlands
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22
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Rendón GJ, Lopez Blanco A, Aragona A, Saadi JM, Di Guilmi J, Arab Eblen C, Heredia Muñoz F, Pareja R. Oncological and obstetrical outcomes after neo-adjuvant chemotherapy followed by fertility-sparing surgery in patients with cervical cancer ≥2 cm. Int J Gynecol Cancer 2020; 31:462-467. [PMID: 33199429 DOI: 10.1136/ijgc-2020-002076] [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: 09/15/2020] [Revised: 10/25/2020] [Accepted: 10/27/2020] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE There is significant debate between up-front radical trachelectomy versus neo-adjuvant chemotherapy before fertility-sparing surgery in patients with tumors ≥2 cm. The aim of this study was to report on the oncological and obstetrical outcome of neo-adjuvant chemotherapy followed by fertility-sparing surgery, in patients diagnosed with cervical cancer ≥2 cm. METHODS This was a retrospective review of patients diagnosed with cervical cancer measuring ≥2 cm to ≤6 cm, who were scheduled to undergo neo-adjuvant chemotherapy before fertility-sparing surgery, at six institutions from four Latin American countries between February 2009 and February 2019. Data collected included: age, International Federation of Gynecology and Obstetrics (FIGO) 2009 stage, histology, tumor size, pre-treatment imaging work-up, chemotherapy agents and number of cycles, toxicity, clinical and imaging response rate, type of fertility-sparing surgery, pathology results, timing of lymphadenectomy, follow-up time, and obstetrical and oncological outcomes. RESULTS A total of 25 patients were included, with a median age of 27 years (range 20-37): 17 patients had stage IB1, 7 had stage IB2 cervical cancer, and 1 patient had stage IIA1 (FIGO 2009); 23 patients had squamous cell carcinoma and 2 patients had adenocarcinoma. The median number of chemotherapy cycles was 3 (range 3-6) and no toxicity grade 3-4 was reported. Lymphadenectomy was performed before chemotherapy in 6 (24%) patients. After neo-adjuvant chemotherapy 20 patients were scheduled for radical trachelectomy (11 abdominal and 9 laparoscopic) and 5 patients for conization. After surgery, no residual disease was found in 11 patients (44%). Fertility was preserved in 23 patients (92%) and 10 patients became pregnant (43.5%). After a median follow-up time of 47 months (13-133), 3 patients had recurrent disease (3/23=13%), 2 were alive without disease, and 1 patient had disease at last contact. CONCLUSION Neo-adjuvant chemotherapy followed by fertility-sparing surgery is feasible in well selected patients with cervical tumors ≥2 cm. Future studies should focus on the timing of lymphadenectomy and type of cervical surgery.
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Affiliation(s)
- Gabriel J Rendón
- Department of Gynecologic Oncology, Instituto de Cancerología - Las Américas - AUNA, Medellín, Colombia
| | - Aldo Lopez Blanco
- Department of Gynecologic Surgery, Instituto Nacional de Enfermedades Neoplásicas, Lima, Perú
| | - Alejandro Aragona
- Department of Gynecologic Oncology, Cancer Hospital of Buenos Aires Marie Curie, Univertsity of Buenos Aires, Buenos Aires, Argentina
| | - José Martín Saadi
- Department of Gynecologic Oncology, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Julian Di Guilmi
- Department of Gynecologic Surgery, Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - Clemente Arab Eblen
- Department of Gynecologic Surgery, Hospital Dr. Luis Tisné, Universidad de Chile, Santiago de Chile, Chile
| | - Fernando Heredia Muñoz
- Department of Gynecology and Obstetrics, Faculty of Medicine, Universidad de Concepción, Concepción, Chile
| | - Rene Pareja
- Department of Gynecologic Oncology, Clínica ASTORGA, Medellin, Colombia.,Department of Gynecology and Obstetrics, Universidad Pontificia Bolivariana, Medellin, Antioquia, Colombia.,Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Bogotá, Colombia
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23
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de Vincenzo R, Ricci C, Fanfani F, Gui B, Gallotta V, Fagotti A, Ferrandina G, Scambia G. Neoadjuvant chemotherapy followed by conization in stage IB2-IIA1 cervical cancer larger than 2 cm: a pilot study. Fertil Steril 2020; 115:148-156. [PMID: 33092819 DOI: 10.1016/j.fertnstert.2020.07.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 07/06/2020] [Accepted: 07/06/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To evaluate feasibility of neoadjuvant chemotherapy (NACT) followed by cold-knife conization (CKC) in patients with 2018 FIGO stage IB2-IIA1 cervical cancer who desired to maintain fertility. DESIGN Pilot study of conization after chemotherapy in stage IB2-IIA1 >2 cm cervical cancer. SETTING University hospital. PATIENT(S) From 2014 to 2018, 25 patients, <40 years of age, were enrolled. INTERVENTIONS(S) After laparoscopic pelvic lymph-node assessment, NACT with cisplatin/paclitaxel q21 was administered to eligible patients. Responsive patients were treated with CKC. MAIN OUTCOME MEASURE(S) Obstetrical outcome: pregnancy rate. Oncologic outcome. RESULT(S) Thirteen out of 25 patients were eligible for fertility-sparing treatment. Oncologic outcome: The clinical overall response rate was 84.5% (11 out of 13 patients). One patient achieved stable disease, was managed by radical surgery, and is still alive; another one experienced progression of disease and died after 15 months. The optimal pathologic response was 69.1%. In the setting of fertility preservation patients, the median follow-up was 37 months (range 18-76). In this group we registered one distant recurrence, 12 months after CKC, in the liver; the patient is still alive and without evidence of disease. Obstetrical outcome: Among the nine patients amenable, three tried to conceive, and two spontaneous pregnancy occurred a few months after the end of treatment, for a pregnancy rate of 66.7%. CONCLUSION(S) This pilot study supports the feasibility of CKC after NACT as conservative treatment in stage IB2-IIA1 cervical cancer, with oncologic outcomes similar to those reported for trachelectomy in the same stage and with potential benefits in terms of obstetrical outcomes. CLINICAL TRIAL REGISTRATION NUMBER NCT02323841.
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Affiliation(s)
- Rosa de Vincenzo
- Università Cattolica del Sacro Cuore, Rome, Italy; Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Caterina Ricci
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Francesco Fanfani
- Università Cattolica del Sacro Cuore, Rome, Italy; Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy.
| | - Benedetta Gui
- Dipartimento di Diagnostica per immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Valerio Gallotta
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Anna Fagotti
- Università Cattolica del Sacro Cuore, Rome, Italy; Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Gabriella Ferrandina
- Università Cattolica del Sacro Cuore, Rome, Italy; Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Giovanni Scambia
- Università Cattolica del Sacro Cuore, Rome, Italy; Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
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24
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Nica A, Covens A. Cone biopsy (with pelvic lymphadenectomy) for fertility preservation in early stage cervical cancer: Ready for prime time? Gynecol Oncol 2020; 158:229-230. [PMID: 32778250 DOI: 10.1016/j.ygyno.2020.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Andra Nica
- University of Toronto, Division of Gynecologic Oncology, Toronto, Ontario, Canada
| | - Allan Covens
- Division of Gynecologic Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Plaikner A, Jacob A, Siegler K, Schneider A, Ragosch V, Barinoff J, Kohler C. Modification of Dargent's radical vaginal trachelectomy to facilitate ureteral dissection: description of technique. Int J Gynecol Cancer 2020; 30:1210-1214. [PMID: 32675055 DOI: 10.1136/ijgc-2020-001478] [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: 04/14/2020] [Revised: 06/09/2020] [Accepted: 06/11/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Radical vaginal trachelectomy is the fertility-preserving surgery for patients with early stage cervical cancer. However, it has not gained widespread approval by gynecologic oncologists because of difficulties in the dissection of the bladder pillars and identification of the ureter during the vaginal portion of the surgery. METHOD We describe a modification of radical vaginal trachelectomy for easier dissection of the bladder pillar. Following pelvic lymphadenectomy, the vesicovaginal space is widely opened laparoscopically. After identification of the uterine arteries, one should proceed along the course of the arteries laterally and, thus, visualize the overcrossing of the artery with the ureter. The medial aspect of the supraureteric bladder pillar is transected and the ureter marked with vessel loops on both sides close to its entry into the bladder. The lateral portion of the supraureteric bladder pillar remains intact. During the vaginal part of radical vaginal trachelectomy, the ureter may be easily found by grasping the formerly placed vessel loop and dissection of the infraureteric bladder pillar may be done without risk of ureteral injury. RESULTS Between October 2018 and August 2019 our group has performed radical vaginal trachelectomy using this modified ureteral dissection in 12 patients. Median operation time was 239 min (range 127-290) and median blood loss was 25 mL (range 10-100). No intra- or post-operative urologic complication occurred. Median time to normal bladder function was 4 days (range 3-13). CONCLUSION The vaginal portion of radical vaginal trachelectomy may be simplified using this technique, especially when difficult circumstances such as endometriosis, prior operations, or unusual anatomy in nulliparous women are encountered.
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Affiliation(s)
- Andrea Plaikner
- Department of Special Operative and Oncologic Gynecology, Asklepios Klinik Altona, Hamburg, Hamburg, Germany
| | - Anna Jacob
- Department of Special Operative and Oncologic Gynecology, Asklepios Klinik Altona, Hamburg, Hamburg, Germany
| | - Kathrin Siegler
- Department of Special Operative and Oncologic Gynecology, Asklepios Klinik Altona, Hamburg, Hamburg, Germany
| | - Achim Schneider
- Center for Dysplasia and Cytology, MVZ Fürstenbergkarree Berlin, Berlin, Germany
| | - Volker Ragosch
- Department of Obstetrics and Gynecology, Asklepios-Clinic Hamburg-Altona, Asklepios Hospital Group, Hamburg, Germany
| | - Jana Barinoff
- Department of Gynecology and Obstetrics, Sankt Gertrauden Krankenhaus GmbH, Berlin, Berlin, Germany
| | - Christhardt Kohler
- Department of Special Operative and Oncologic Gynecology, Asklepios Klinik Altona, Hamburg, Hamburg, Germany.,Department of Gynecology, University of Cologne, Koln, Germany
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Floyd JL, Campbell S, Rauh-Hain JA, Woodard T. Fertility preservation in women with early-stage gynecologic cancer: optimizing oncologic and reproductive outcomes. Int J Gynecol Cancer 2020; 31:345-351. [PMID: 32565487 DOI: 10.1136/ijgc-2020-001328] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/20/2020] [Accepted: 05/21/2020] [Indexed: 12/22/2022] Open
Abstract
Almost all standard therapies for gynecologic cancer, including surgical intervention, gonadotoxic chemotherapy, and radiation therapy, threaten a woman's childbearing potential. Preservation of fertility should be discussed with premenopausal women with early-stage gynecologic cancer shortly after diagnosis and, for women who desire to preserve fertility, during treatment planning. Many authors have investigated both oncologic and reproductive outcomes following fertility-sparing therapy, and there is ongoing development of assisted reproduction techniques available to cancer patients and survivors. Women with early-stage (IA1-IB1) cervical cancer may be candidates for fertility-sparing cervical conization, simple trachelectomy, or radical trachelectomy. In women with stage I epithelial ovarian cancer, fertility-sparing surgery appears safe overall, although controversy remains in patients with high-risk features (eg, high pathologic grade, clear cell histology, or stage IC disease). In women with low-grade, early-stage endometrial cancer, hormonal therapy has emerged as a viable option. Criteria for patient selection for fertility-sparing therapy are not well defined, thus patients and providers must carefully discuss potential risks and benefits. In general, in carefully selected patients, survival outcomes do not appear to differ significantly between radical and fertility-sparing approaches. Women who undergo fertility-sparing therapies may experience a number of fertility and obstetric complications. Preconception counseling with high-risk obstetric specialists is important to optimize health before a woman attempts to conceive. Identifying appropriate candidates for fertility-sparing treatments, assessing fertility potential, and helping women conceive after cancer treatment is best accomplished through multidisciplinary collaboration between gynecologic oncologists and fertility specialists.
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Affiliation(s)
- Jessica Lauren Floyd
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA
| | - Sukhkamal Campbell
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Baylor College of Medicine, Houston, TX, USA
| | - Jose Alejandro Rauh-Hain
- Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Terri Woodard
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Baylor College of Medicine, Houston, TX, USA .,Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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27
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Plante M, Renaud MC, Sebastianelli A, Gregoire J. Simple vaginal trachelectomy in women with early-stage low-risk cervical cancer who wish to preserve fertility: the new standard of care? Int J Gynecol Cancer 2020; 30:981-986. [PMID: 32499393 DOI: 10.1136/ijgc-2020-001432] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/13/2020] [Accepted: 05/14/2020] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE There is a trend toward less radical surgery in women with small-volume disease who wish to preserve fertility. The objective of our study was to evaluate the oncologic and obstetrical outcome of simple vaginal trachelectomy and lymph node assessment in patients with low-risk early-stage cervical cancer (<2 cm). METHODS From May 2007 to January 2020, 50 patients underwent a simple vaginal trachelectomy/conization with laparoscopic sentinel lymph node mapping±complete pelvic node dissection. Patients underwent loop electrocautery excision (LEEP), cone/cervical biopsies, or simple trachelectomy. A preoperative pelvic MRI with gadolinium contrast was systematically performed in all cases. The size of the lesion was established by review of the LEEP, cone or trachelectomy specimen, MRI, and clinical examination. Data was collected prospectively in a computerized database. Descriptive statistics and the Kaplan-Meier estimate were used for analysis. RESULTS The median age was 29 years (range: 21-44) and 35 (70%) patients were nulliparous. As per FIGO 2009 classification, 11 patients had stage IA1 with lymphovascular space invasion (LVSI), 13 patients had stage IA2, and 26 patients had stage IB1. Twenty-six patients had squamous histology, 20 patients adenocarcinoma, and four patients other histologies. On final pathology, lymph nodes were negative in 46 patients (92%), three patients had isolated tumor cells, and one patient had micrometastasis. Thirty patients (60%) had either no residual disease in the trachelectomy specimen (22) or residual dysplasia only (eight). With a median follow-up of 76 months (range: 1-140), only one local recurrence occurred which was treated initially with chemoradiation. She recurred again locally and underwent a pelvic exenteration: the patient progressed again and died of disease. The 5-year progression-free survival and overall survival was 97.9% and 97.6%, respectively. There were 40 pregnancies: five (12.5%) ended in the first trimester, one (2.5%) in the second trimester, and three (7.5%) were late preterm: all the others (30 or 75%) delivered >36 weeks and one pregnancy is ongoing. CONCLUSION Simple trachelectomy/conization and lymph node assessment is an oncologically safe fertility-preserving surgery in well-selected patients with low-risk early-stage cervical cancer (<2 cm). Obstetrical outcomes are comparable to the general population.
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Affiliation(s)
- Marie Plante
- Gynecologic Oncology, CHU de Quebec; LHotel-Dieu de Quebec, Quebec City, Quebec, Canada
| | - Marie-Claude Renaud
- Gynecologic Oncology, CHU de Quebec; LHotel-Dieu de Quebec, Quebec City, Quebec, Canada
| | | | - Jean Gregoire
- Gynecologic Oncology, CHU de Quebec; LHotel-Dieu de Quebec, Quebec City, Quebec, Canada
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Zusterzeel PL, Aarts JW, Pol FJ, Ottevanger PB, van Ham MA. Neoadjuvant Chemotherapy Followed by Vaginal Radical Trachelectomy as Fertility-Preserving Treatment for Patients with FIGO 2018 Stage 1B2 Cervical Cancer. Oncologist 2020; 25:e1051-e1059. [PMID: 32339376 PMCID: PMC7356752 DOI: 10.1634/theoncologist.2020-0063] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 03/27/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Standard treatment for International Federation of Gynecology and Obstetrics (FIGO) 2018 stage 1B2 cervical cancer (i.e., tumor size between 2 and 4 cm) is a radical hysterectomy (RH) with pelvic lymph node dissection (PLND). We evaluated the oncological and fertility outcomes treatment in patients receiving a fertility-sparing alternative consisting of neoadjuvant chemotherapy (NACT) followed by vaginal radical trachelectomy (VRT). METHODS Patients with stage 1B2 cervical cancer who wished to preserve fertility were included from September 2009 to September 2018. NACT consisted of 6-week cycles of cisplatin or carboplatin with paclitaxel. If tumor size decreased to 2 cm or smaller, NACT was followed by a robot-assisted PLND and VRT. RESULTS Eighteen patients were included. Median follow-up time was 49.7 months (range 11.4-110.8). Median tumor size was 32 mm (range 22-40 mm). Complete remission after NACT occurred in seven women. Four women had a poor response on NACT. Three underwent RH with PLND; one received chemoradiation after PLND instead of VRT because of positive lymph nodes. The remaining 14 patients received VRT 3-4 weeks after NACT. Four recurrences occurred: three after NACT and VRT and one after NACT and RH. Median time to recurrence was 20.8 months (range 17.0-105.7). Three recurrences occurred in women with adenocarcinoma with lymph vascular space invasion (LVSI). In four women fertility could not be preserved. To date, four women had six pregnancies, including three live births born at term, two first trimester miscarriages, and one currently ongoing pregnancy. CONCLUSION NACT and VRT in women with stage 1B2 cervical cancer showed promising results. In 78% fertility was preserved. However, patients with poor response on NACT and with adenocarcinoma and/or LVSI were possibly at risk for recurrence. Long-term results in relation to fertility and oncological outcome are needed to corroborate these findings. IMPLICATIONS FOR PRACTICE Standard treatment for women with International Federation of Gynecology and Obstetrics (FIGO) 2018 stage 1B2 cervical cancer (tumor size 2-4 cm) is a radical hysterectomy and pelvic lymph node dissection (PLND). However, many of these women are young and wish to preserve fertility. Data on fertility-sparing treatment options are sparse, but neoadjuvant chemotherapy followed by a vaginal radical trachelectomy and PLND could be an alternative. Since 2009 we performed an observational cohort study in which 18 women opted for this treatment in our center. In 14 women fertility could be preserved. In four patients the tumor recurred. In four women six pregnancies occurred. After careful selection this treatment could be a good fertility-sparing treatment option.
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Affiliation(s)
- Petra L.M. Zusterzeel
- Department of Obstetrics and Gynecology, Radboud University Medical CenterNijmegenThe Netherlands
| | - Johanna W.M. Aarts
- Department of Obstetrics and Gynecology, Radboud University Medical CenterNijmegenThe Netherlands
| | - Fraukje J.M. Pol
- Department of Obstetrics and Gynecology, Radboud University Medical CenterNijmegenThe Netherlands
| | | | - Maaike A.P.C. van Ham
- Department of Obstetrics and Gynecology, Radboud University Medical CenterNijmegenThe Netherlands
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Redistribution of Cervix Cancer Patients from FIGO 2009 to FIGO 2018 Staging Following Incorporation of Medical Imaging. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2019. [DOI: 10.1007/s40944-019-0347-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kim S, Chung S, Azodi M, Menderes G. Uterine Artery–sparing Minimally Invasive Radical Trachelectomy: A Case Report and Review of the Literature. J Minim Invasive Gynecol 2019; 26:1389-1395. [DOI: 10.1016/j.jmig.2019.05.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/21/2019] [Accepted: 05/22/2019] [Indexed: 11/28/2022]
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Duenas-Gonzalez A, Gonzalez-Fierro A. Pharmacodynamics of current and emerging treatments for cervical cancer. Expert Opin Drug Metab Toxicol 2019; 15:671-682. [DOI: 10.1080/17425255.2019.1648431] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Alfonso Duenas-Gonzalez
- Unit of Biomedical Research on Cancer, Instituto de Investigaciones Biomédicas UNAM/Instituto Nacional de Cancerología, Mexico City, Mexico
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Long-term results of fertility-sparing treatment for early-stage cervical cancer. Gynecol Oncol 2019; 154:89-94. [DOI: 10.1016/j.ygyno.2019.04.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 04/01/2019] [Accepted: 04/06/2019] [Indexed: 11/21/2022]
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The security of radical trachelectomy in the treatment of IA–IIA cervical carcinoma requires further evaluation: updated meta-analysis and trial sequential analysis. Arch Gynecol Obstet 2019; 299:1525-1536. [DOI: 10.1007/s00404-019-05141-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 03/25/2019] [Indexed: 10/27/2022]
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Fokom Domgue J, Schmeler KM. Conservative management of cervical cancer: Current status and obstetrical implications. Best Pract Res Clin Obstet Gynaecol 2019; 55:79-92. [DOI: 10.1016/j.bpobgyn.2018.06.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 06/01/2018] [Accepted: 06/04/2018] [Indexed: 01/27/2023]
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Abstract
Each year, more than half a million women are diagnosed with cervical cancer and the disease results in over 300 000 deaths worldwide. High-risk subtypes of the human papilloma virus (HPV) are the cause of the disease in most cases. The disease is largely preventable. Approximately 90% of cervical cancers occur in low-income and middle-income countries that lack organised screening and HPV vaccination programmes. In high-income countries, cervical cancer incidence and mortality have more than halved over the past 30 years since the introduction of formal screening programmes. Treatment depends on disease extent at diagnosis and locally available resources, and might involve radical hysterectomy or chemoradiation, or a combination of both. Conservative, fertility-preserving surgical procedures have become standard of care for women with low-risk, early-stage disease. Advances in radiotherapy technology, such as intensity-modulated radiotherapy, have resulted in less treatment-related toxicity for women with locally-advanced disease. For women with metastatic or recurrent disease, the overall prognosis remains poor; nevertheless, the incorporation of the anti-VEGF agent bevacizumab has been able to extend overall survival beyond 12 months. Preliminary results of novel immunotherapeutic approaches, similarly to other solid tumours, have shown promising results so far.
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Affiliation(s)
- Paul A Cohen
- Department of Gynaecological Oncology, Bendat Family Comprehensive Cancer Centre, St John of God Subiaco Hospital, Subiaco, Western Australia, WA, Australia; Division of Obstetrics and Gynaecology, Faculty of Health and Medical Sciences, University of Western Australia, Crawley, Western Australia, WA, Australia.
| | - Anjua Jhingran
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, TX, USA
| | - Ana Oaknin
- Medical Oncology Department, Gynaecological Tumour Unit, Vall d'Hebron University Hospital, Vall d'Hebron, Institute of Oncology (VHIO), Barcelona, Spain
| | - Lynette Denny
- Department Obstetrics and Gynaecology, University of Cape Town, Cape Town, South Africa; South African Medical Research Council, Gynaecological Cancer Research Centre, Tygerberg, South Africa
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Glickman AG, Valdes S, Gil-Ibañez B, Paredes P, Cortés KS, Torné Blade AA. Present status of sentinel lymph node biopsy in cervical cancer. Rep Pract Oncol Radiother 2018; 23:495-502. [PMID: 30534012 PMCID: PMC6277279 DOI: 10.1016/j.rpor.2018.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Revised: 02/17/2018] [Accepted: 04/08/2018] [Indexed: 02/06/2023] Open
Abstract
Cervical cancer is the fourth most common cancer in women, and seventh overall. This disease represents a medical, economic and social burden. In early FIGO stage patients (IA, IB1 and IIA1), nodal involvement is the most important prognostic factor. Imaging evaluation of nodal metastasis is of limited value. In order to determine lymph node involvement, allow loco-regional control of the disease, define the need for adjuvant radiotherapy and improve survival, standard surgery for early disease is radical hysterectomy with systematic pelvic lymphadenectomy. However, this surgical treatment has risks and complications: longer operative time, larger blood loss, neurovascular or ureteral injury, lower-limb lymphedema, symptomatic lymphocysts, hydronephrosis. A method that allows to define the presence of regional metastasis with less morbidity and equal or greater precision is particularly relevant. The use of the sentinel lymph node biopsy is intended to reach that purpose. The present study reviews recent literature on the role of sentinel lymph node biopsy in cervical cancer, analyzing its indications and contraindications, injection and detection techniques, tracers used, surgical and pathological approaches and its applicability in up-to-date clinical practice.
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Affiliation(s)
- Ariel Gustavo Glickman
- Gynecological Oncology Unit, Barcelona Clinic Hospital, 170 Villaroel St, Barcelona 08036, Spain
| | - Sergio Valdes
- Gynecological Oncology Unit, Barcelona Clinic Hospital, 170 Villaroel St, Barcelona 08036, Spain
| | - Blanca Gil-Ibañez
- Gynecological Oncology Unit, Barcelona Clinic Hospital, 170 Villaroel St, Barcelona 08036, Spain
| | - Pilar Paredes
- Nuclear Medicine, Barcelona Clinic Hospital, 170 Villaroel St, Barcelona 08036, Spain
| | | | - Aureli Angel Torné Blade
- Gynecological Oncology Unit, Barcelona Clinic Hospital, 170 Villaroel St, Barcelona 08036, Spain
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Zhou L, Sun CT, Lin L, Xie Y, Huang Y, Li Q, Liu X. Independent risk factors for ovarian metastases in stage IA-IIB cervical carcinoma. Acta Obstet Gynecol Scand 2018; 98:18-23. [PMID: 30129170 DOI: 10.1111/aogs.13442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 08/08/2018] [Accepted: 08/13/2018] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Cervical cancer is a common malignant tumor in women; most cervical cancer patients are premenopausal. Ovarian resection or preservation remains controversial. The purpose of this study was to discover the risk factors for ovarian metastasis in women with stage I-II cervical cancer. MATERIAL AND METHODS A total of 3292 women with cervical carcinoma who had undergone radical hysterectomy, with pelvic lymphadenectomy and bilateral oophorectomy or wedge resection of ovaries, were included in this multicenter retrospective study. We analyzed patients' demographics, International Federation of Obstetrics and Gynecology stage, and histopathologic records to determine clinicopathologic risk factors of ovarian metastasis. RESULTS Of the patients, 115 (3.49%) were confirmed to have ovarian metastasis. The ovarian metastasis rate was 2% (56/2794) for squamous cell carcinoma and 11.8% (59/498) for nonsquamous cell carcinoma. The risk factors independently associated with ovarian metastasis were histologic type (odds ratio [OR] 8.76, 95% CI 2.09-19.24), lymph node metastasis (OR 2.57, 95% CI 1.76-4.89), lymphovascular space invasion (OR 2.82, 95% CI 1.98-4.24), and corpus invasion (OR 6.34, 95% CI 2.37-11.42). CONCLUSIONS The histologic type, lymph node metastasis, lymphovascular space invasion, and corpus invasion were independently associated with ovarian metastasis. Histologic type and corpus invasion were the most important risk factors. Therefore, we suggest that corpus invasion might be a strong contraindication for preservation of the ovaries.
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Affiliation(s)
- Le Zhou
- Health Management Department, West China Hospital of Sichuan University, Chengdu, China.,Obstetrics and Gynecology Department, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Chun-Tang Sun
- Department of Radiation Oncology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, Chengdu, China
| | - Lin Lin
- Obstetrics and Gynecology Department, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yao Xie
- Obstetrics and Gynecology Department, Sichuan People's Hospital, Chengdu, China
| | - Yan Huang
- Health Management Department, West China Hospital of Sichuan University, Chengdu, China
| | - Qiao Li
- Health Management Department, West China Hospital of Sichuan University, Chengdu, China
| | - Xinghui Liu
- Obstetrics and Gynecology Department, West China Second University Hospital, Sichuan University, Chengdu, China
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Arora V, Somashekhar S. Essential surgical skills for a gynecologic oncologist. Int J Gynaecol Obstet 2018; 143 Suppl 2:118-130. [DOI: 10.1002/ijgo.12619] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Vivek Arora
- Royal Hospital for Women; University of New South Wales Randwick; Sydney Australia
| | - S.P. Somashekhar
- Manipal Comprehensive Cancer Center; Manipal Hospital; Bangalore India
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Ovarian conservation is associated with better survival in young patients with T1N0M0 cervical adenocarcinoma: a population-based study. Arch Gynecol Obstet 2018; 297:775-784. [PMID: 29362924 DOI: 10.1007/s00404-018-4674-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 01/15/2018] [Indexed: 02/03/2023]
Abstract
PURPOSE Ovarian conservation is controversial in patients with cervical adenocarcinoma due to the risk of ovarian metastasis. The aim of this study is to evaluate the association of ovarian conservation with survival outcomes in young patients with T1N0M0 cervical adenocarcinoma. METHODS Women who were 45 years of age or younger with T1N0M0 cervical adenocarcinoma from 1988 to 2013 recorded in the Surveillance, Epidemiology, and End Results (SEER) database were included. Propensity score weighting was used to balance the intragroup differences. Cause-specific survival (CSS) and overall survival (OS) were compared using Kaplan-Meier estimates. A multivariate Cox model was used to adjust for covariates including propensity score. A stratified analysis was then conducted. RESULTS Totally, 1090 (79.7%) patients underwent oophorectomy and 278 (20.3%) patients whose ovaries were preserved were identified. Patients with preserved ovaries were younger, with a lower T classification and less likely to undergo pelvic lymphadenectomy (all p < 0.05). After propensity weighting, ovarian conservation group had better cause-specific survival (CSS) (5-year 98.8 versus 97.1%, 10-year 98.0 versus 95.2%, p = 0.0370) and overall survival (OS) (5-year 98.8 versus 97.1%, 10-year 96.5 versus 93.5%, p = 0.0025). After adjustment, the CSS benefit of ovarian conservation was marginally significant (p = 0.051) and OS benefit was still significant (p = 0.006). Stratified analysis showed that the CSS benefit was found in T1b classification (HR, 0.23; 95% CI 0.06-0.89, p = 0.033) and histological grade > 1 (HR 0.12; 95% CI 0.02-0.87; p = 0.035). CONCLUSION Among young women with T1N0M0 cervical adenocarcinoma, ovarian conservation is associated with better survival.
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Is fertility-preservation safe for adult non-metastatic gynecologic rhabdomyosarcoma patients? Systematic review and pooled survival analysis of 137 patients. Arch Gynecol Obstet 2017; 297:559-572. [DOI: 10.1007/s00404-017-4591-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 11/10/2017] [Indexed: 11/26/2022]
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McEvoy SH, Nougaret S, Abu-Rustum NR, Vargas HA, Sadowski EA, Menias CO, Shitano F, Fujii S, Sosa RE, Escalon JG, Sala E, Lakhman Y. Fertility-sparing for young patients with gynecologic cancer: How MRI can guide patient selection prior to conservative management. Abdom Radiol (NY) 2017; 42:2488-2512. [PMID: 28528388 PMCID: PMC5857967 DOI: 10.1007/s00261-017-1179-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Historically, cancer treatment has emphasized measures for the "cure" regardless of the long-term consequences. Advances in cancer detection and treatment have resulted in improved outcomes bringing to the fore various quality of life considerations including future fertility. For many young cancer patients, fertility preservation is now an integral component of clinical decision-making and treatment design. Optimal fertility-sparing options for young patients with gynecologic cancer are influenced by patient age, primary cancer, treatment regimens, and patient preferences. Possible approaches include embryo or oocyte cryopreservation, ovarian transposition, conservative surgery, and conservative medical treatment to delay radical surgery. These may be used alone or in combination to maximize fertility preservation. Awareness of the various fertility-sparing options, eligibility criteria, and the central role of magnetic resonance imaging in the proper selection of patients will enable radiologists to produce complete clinically relevant imaging reports and serve as effective consultants to referring clinicians. Knowledge of the potential imaging pitfalls is essential to avoid misinterpretation and guide appropriate management.
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Affiliation(s)
- Sinead H McEvoy
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
- Department of Radiology, The Christie NHS Foundation, 550 Wilmslow Rd, Manchester, M20 4BX, UK.
| | - Stephanie Nougaret
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Radiology, Institut Régional du Cancer de Montpellier, Montpellier, France
- IRCM, Institut de Recherche en Cancérologie de Montpellier, INSERM, U1194, Montpellier, France
| | - Nadeem R Abu-Rustum
- Gynecologic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | | | | | | | - Fuki Shitano
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shinya Fujii
- Division of Radiology, Department of Pathophysiological and Therapeutic Science, Faculty of Medicine, Tottori University, Yonago, Japan
| | - Ramon E Sosa
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joanna G Escalon
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Radiology, New York-Presbyterian Hospital-Weill Cornell Medical Center, New York, NY, USA
| | - Evis Sala
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yulia Lakhman
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Fertility Sparing Surgery for Cervical Cancer: Practice Points. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2017. [DOI: 10.1007/s40944-017-0144-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Intention-to-Treat Analysis of Radical Trachelectomy for Early-Stage Cervical Cancer With Special Reference to Oncologic Failures: Single-Institutional Experience in Hungary. Int J Gynecol Cancer 2017; 27:1438-1445. [DOI: 10.1097/igc.0000000000001048] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
ObjectiveThe aim of our study was to evaluate clinical and pathological data in order to draw eligibility criteria for oncologically sufficient radical trachelectomy (RT) in early-stage cervical cancer. Reviewing all cases of attempted RT performed at our unit, we focused attention on prognostic indicators of the need for additional oncologic treatment following RT. The analysis was extended by extensive literature review to include previously published cases of oncologic failures.MethodsThe authors retrospectively analyzed data of patients who underwent RT at the Department of Obstetrics and Gynecology, University of Debrecen. Electronic records and case notes of RT cases were reviewed to determine the incidence of abdominal and vaginal route, distribution of clinicopathologic data, and follow-up results of individual cases. Individual procedures were categorized as oncologically insufficient if additional oncologic treatment was necessary following RT. Theoretical eligibility criteria for RT in early-stage cervical cancer were determined retrospectively by selecting prognostic features that were associated with oncologic insufficiency from clinicopathologic indicators of the complete series.ResultsTwenty-four cases of RT were performed by the authors, 15 vaginal RTs with laparoscopic pelvic lymphadenectomy and 9 abdominal RTs with open pelvic lymphadenectomy. Fifteen of 24 cases proved oncologically sufficient. Three cases required immediate conversion to radical hysterectomy because of positive sentinel nodes and/or positive isthmic disc on frozen section. In further 5 cases, final pathology results indicated additional oncologic treatment, that is, radical hysterectomy (n = 2), chemoradiotherapy (n = 2), or chemotherapy (n = 1). One patient among immediately converted cases and another 3 among those who required additional oncologic treatment died of their disease later. There were no other cases of recurrences over a median follow-up of 34 months (range, 12–188 months). Factors that may predict oncologic insufficiency of RT were stage IB1 or greater, tumor size of greater than 2 cm in 1 dimension or greater than 15 mm in 3 dimensions, G3, nonsquamous/adeno histological type, stromal invasion of greater than 9 mm, and lymphovascular space involvement in the primary tumor.ConclusionsMost cases of oncologically insufficient RTs have significant risk features that can be identified preoperatively. There is a need for more clinicopathologic data on oncologic failure of RT cases in order to improve patient selection.
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Morgan EL, Sanday K, Budd A, Hammond IG, Nicklin J. Cervical cancer in women under 25 years of age in Queensland, Australia: To what extent is the diagnosis made by screening cytology? Aust N Z J Obstet Gynaecol 2017; 57:469-472. [PMID: 28580578 DOI: 10.1111/ajo.12640] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 04/10/2017] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The current Australian National Cervical Screening Program (NCSP) involves biennial, cytology-based screening of women from the age of 18 years. From December, 2017 this will change to a five-yearly human papilloma virus-based screening commencing at age 25. There is some concern that the new program may delay the opportunistic detection of cervical cancers in women under 25 years. AIM (1) To review all cases of invasive cervical cancer in Queensland women under the age of 25 over the last 28 years. (2) To determine symptoms and screening history prior to diagnosis. METHODS A retrospective cohort study was undertaken at the Queensland Centre for Gynaecological Cancer (QCGC) and the Queensland Cancer Registry (QCR) of all women aged between 13 and 25 years diagnosed with cervical cancer in Queensland between 1984 and 2012. Demographic data and symptoms prior to diagnosis were extracted from the QCGC and QCR databases. RESULTS A total of 56 women aged 13-25, were diagnosed with cervical cancer and treated at the QCGC between 1984 and 2012. The commonest reason for the diagnosis of cancer was investigation of abnormal symptoms (n = 22, 39%) rather than routine Pap smear abnormalities (n = 15, 26%). CONCLUSIONS Consistent with the world literature, there is a very low incidence of cervical cancer in women under 25 years of age, irrespective of the age of commencement of screening, or the screening interval. Our study lends some support to the proposed commencement age of 25 years in the new NCSP.
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Affiliation(s)
| | - Karen Sanday
- Queensland Centre for Gynaecological Cancer, Royal Women's Hospital, Brisbane, Queensland, Australia
| | - Alison Budd
- Cancer & Screening Unit, Australian Institute of Health and Welfare ACT, Canberra, Australian Capital Territory, Australia
| | - Ian G Hammond
- School of Women's and Infants Health, University of Western Australia, Crawley, Western Australia, Australia
| | - James Nicklin
- Queensland Centre for Gynaecological Cancer, Royal Women's Hospital, Brisbane, Queensland, Australia
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Laparoscopic Abdominal Cerclage. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2016. [DOI: 10.1007/s13669-016-0179-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Fertility-Sparing Options for Early Cervical Cancer: Optimism for Oncologic and Obstetric Outcomes. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2016. [DOI: 10.1007/s13669-016-0177-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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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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Vaginal Radical Trachelectomy for Early-Stage Cervical Cancer: Increased Recurrence Risk for Adenocarcinoma. Int J Gynecol Cancer 2016; 26:1293-9. [DOI: 10.1097/igc.0000000000000763] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ObjectiveTo evaluate consecutive vaginal radical trachelectomies (VRTs) in early-stage cervical cancer in the 2 main referral centers for fertility-preserving surgery in the Netherlands.Materials and MethodsOncology, fertility, and obstetrical data were recorded in a regional database of all VRTs without neoadjuvant chemotherapy performed in 2 major referral centers between 2000 and 2015.ResultsMost of the patients (91.7%) had stage IB1 disease. In 72.0%, squamous cell carcinoma was the histologic diagnosis; in 24.2%, adenocarcinoma; and in 3.8%, adenosquamous carcinoma. The median follow-up was 51 months.Nine (6.8%) recurrences occurred, 4 resulting in death of disease (death rate, 3.0%). Recurrence rates were 12.5% for adenocarcinoma, 20% for adenosquamous carcinoma, and 4.2% for squamous cell carcinoma (P < 0.01).From 117 women, data about fertility and obstetrical outcome were obtained. Almost 60% of women attempted to conceive after a VRT. Of these women, 40% needed fertility treatment. A total of 47 pregnancies were established, and a total of 37 children were born of which 30 (81.1%) were delivered after 32 weeks of gestational age.ConclusionsNonsquamous cell histology and high-grade disease are associated with a significantly higher risk of recurrence in the univariate and multivariate analyses. Women with both these histology features should be counseled reticently for VRT.Pregnancies after VRT must be regarded as high-risk pregnancies with a high prematurity rate.
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