title: Neoadjuvant chemotherapy followed by radical vaginal trachelectomy and adjuvant chemotherapy for clear cell cancer of the cervix: a feasible approach and review.
abstract: BACKGROUND
  Clear cell adenocarcinoma of the cervix (CCAC) may affect pediatric and younger women in absence of diethylstilbestrol exposure and other classic predisposing factors for cervical cancer. Prognosis is similar for early-stage CCAC, squamous cell cancer and non-clear cell adenocarcinoma of the cervix. Vaginal radical trachelectomy (VRT) and abdominal radical trachelectomy (ART) with pelvic lymph node dissection have evolved as valuable fertility-preserving treatment options. Neoadjuvant chemotherapy (NACT) before abdominal radical trachelectomy/VRT may reduce tumor size and thereby facilitate surgery. In some cases, adjuvant treatment in the presence of high-risk prognostic features may be required to optimize treatment.
  
  
  METHODS
  A 13-year-old adolescent with International Federation of Obstetrics and Gynecology stage IB1 CCAC was treated with NACT using carboplatin and paclitaxel (CP) followed by laparoscopic pelvic lymphadenectomy, VRT, and adjuvant chemotherapy.
  
  
  RESULTS
  Neoadjuvant chemotherapy using CP was well tolerated with no toxicity. Neoadjuvant chemotherapy reduced the tumor size and facilitated radical vaginal trachelectomy. Adjuvant treatment was recommended in the presence of risk factors. The patient elected to conserve the uterus and underwent 3 further cycles of adjuvant chemotherapy with CP.
  
  
  CONCLUSIONS
  This is the first reported case of CCAC treated with NACT using CP followed by laparoscopic pelvic lymphadenectomy, VRT, and adjuvant chemotherapy. A successful treatment outcome achieved using this novel approach suggests its applicability in selected cases.
authors.affiliation: Queensland Centre for Gynaecological Cancer, Royal Brisbane and Women's Hospital, Brisbane, Australia. drpiksi5@yahoo.com.au
authors.forename: Piksi
authors.initials: P
authors.lastname: Singh
authors.forename: James
authors.initials: J
authors.lastname: Nicklin
authors.forename: Timothy
authors.initials: T
authors.lastname: Hassall
mesh_terms: D018262:Adenocarcinoma, Clear Cell / Q000188:drug therapy* / Q000601:surgery*; D000293:Adolescent; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016190:Carboplatin / Q000008:administration & dosage; D002584:Cervix Uteri / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D020360:Neoadjuvant Therapy; D017239:Paclitaxel / Q000008:administration & dosage; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy* / Q000601:surgery*
chemical_list: D016190:Carboplatin; D017239:Paclitaxel