Conization and lymph node evaluation as a fertility-sparing treatment for early stage cervical cancer

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.

[1]  F. Peccatori,et al.  Fertility preservation in women with cervical cancer. , 2020, Critical reviews in oncology/hematology.

[2]  M. Plante,et al.  Simple vaginal trachelectomy in women with early-stage low-risk cervical cancer who wish to preserve fertility: the new standard of care? , 2020, International Journal of Gynecological Cancer.

[3]  G. Bogani,et al.  Long-term results of fertility-sparing treatment for early-stage cervical cancer. , 2019, Gynecologic oncology.

[4]  A. Oza,et al.  FIGO 2018 stage IB2 (2–4 cm) Cervical cancer treated with Neo-adjuvant chemotherapy followed by fertility Sparing Surgery (CONTESSA); Neo-Adjuvant Chemotherapy and Conservative Surgery in Cervical Cancer to Preserve Fertility (NEOCON-F). A PMHC, DGOG, GCIG/CCRN and multicenter study , 2019, International Journal of Gynecological Cancer.

[5]  P. Hillemanns,et al.  SENTICOL III: an international validation study of sentinel node biopsy in early cervical cancer. A GINECO, ENGOT, GCIG and multicenter study , 2019, International Journal of Gynecological Cancer.

[6]  K. Schmeler,et al.  Conservative management of cervical cancer: Current status and obstetrical implications. , 2019, Best practice & research. Clinical obstetrics & gynaecology.

[7]  P. Dundr,et al.  A prospective multicenter trial on sentinel lymph node biopsy in patients with early-stage cervical cancer (SENTIX) , 2019, International Journal of Gynecologic Cancer.

[8]  D. Aoki,et al.  Cancer of the cervix uteri , 2018, International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics.

[9]  A. Jemal,et al.  Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries , 2018, CA: a cancer journal for clinicians.

[10]  F. Landoni,et al.  Conization in Early Stage Cervical Cancer: Pattern of Recurrence in a 10-Year Single-Institution Experience , 2017, International Journal of Gynecologic Cancer.

[11]  Cyrus Chargari,et al.  Oncological outcomes after fertility-sparing surgery for cervical cancer: a systematic review. , 2016, The Lancet. Oncology.

[12]  M. Carcangiu,et al.  How often parametrial involvement leads to post-operative adjuvant treatment in locally advanced cervical cancer after neoadjuvant chemotherapy and type C radical hysterectomy? , 2015, European Journal of Surgical Oncology.

[13]  P. Ramirez,et al.  Immediate radical trachelectomy versus neoadjuvant chemotherapy followed by conservative surgery for patients with stage IB1 cervical cancer with tumors 2cm or larger: A literature review and analysis of oncological and obstetrical outcomes. , 2015, Gynecologic oncology.

[14]  M. Plante.  Evolution in Fertility-Preserving Options for Early-Stage Cervical Cancer: Radical Trachelectomy, Simple Trachelectomy, Neoadjuvant Chemotherapy , 2013, International Journal of Gynecologic Cancer.

[15]  P. Ramirez,et al.  Management of low-risk early-stage cervical cancer: should conization, simple trachelectomy, or simple hysterectomy replace radical surgery as the new standard of care? , 2014, Gynecologic oncology.

[16]  L. G. Koss,et al.  Cervical Cancer , 1981, Current Topics in Pathology.