Fertility-sparing management for bulky cervical cancer using neoadjuvant transuterine arterial chemotherapy followed by vaginal trachelectomy.
BACKGROUND
Fertility-sparing management for bulky cervical cancer remains under investigation. We investigated the safety of neoadjuvant transuterine arterial chemotherapy (TUAC) followed by a simple vaginal trachelectomy for patients with tumors larger than 3 cm in diameter who desired uterine preservation.


METHODS
First, to assess the safety and efficacy of TUAC, survival and pathological complete response data from 39 patients with a diagnosis of stage IB2 to stage IIB cervical cancer who participated in 2 consecutive trials during 1997-2006 were analyzed. The neoadjuvant chemotherapy regimens were a combination of TUAC using cisplatin with intravenous nedaplatin or irinotecan. Second, to assess the safety of fertility-sparing management with TUAC, medical records of patients matching the following criteria were reviewed during the same period: (1) International Federation of Gynecology and Obstetrics stages IB1 to IIA; (2) maximum diameter of tumor, 3 cm or more; (3) squamous cell carcinoma; (4) no radiological findings of lymph node metastasis; and (5) patient's strong desire for preservation of the uterus and to undergo TUAC.


RESULTS
The overall 5-year survival rate of the 39 enrolled patients was 81.0% (95% confidence interval, 64.8%-93.7%). No malignant cells were found in pathologically examined surgical specimens from 14 patients (35.9%), all of whom were alive without recurrence for more than 7 years after treatment. Based on medical records, 7 patients were eligible according to the fertility-sparing criteria, 1 patient with International Federation of Gynecology and Obstetrics stage IB1 cancer, 5 patients with stage IB2, and 1 patient with stage IIA. One patient with stage IB1 cancer and 2 patients with stage IB2 cancer underwent simple vaginal trachelectomy, resection of paracervical tissues, and abdominal lymphadenectomy. Their disease-free intervals were 86, 120, and 65 months, respectively. All 3 patients had regular menses after surgery but no pregnancies, for personal reasons unrelated to fertility.


CONCLUSIONS
Powerful neoadjuvant chemotherapy regimens resulted in a pathological complete response. Long-term disease-free interval was achieved after fertility-sparing management for bulky cervical cancer in 3 cases.
Department of Obstetrics and Gynecology, Hyogo College of Medicine, Hyogo, Japan. tsuba@hyo-med.ac.jp
Hiroshi
H
Tsubamoto
Riichiro
R
Kanazawa
Kayo
K
Inoue
Yoshihiro
Y
Ito
Shinji
S
Komori
Hiroaki
H
Maeda
Shozo
S
Hirota
D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D002166:Camptothecin / Q000031:analogs & derivatives / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D002584:Cervix Uteri / Q000473:pathology; D017024:Chemotherapy, Adjuvant; D002945:Cisplatin / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D000077146:Irinotecan; D008197:Lymph Node Excision; D020360:Neoadjuvant Therapy; D009944:Organoplatinum Compounds / Q000627:therapeutic use; D011247:Pregnancy; D012189:Retrospective Studies; D055357:Uterine Artery Embolization; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D014621:Vagina / Q000601:surgery*
D000970:Antineoplastic Agents; D009944:Organoplatinum Compounds; D000077146:Irinotecan; C053989:nedaplatin; D002945:Cisplatin; D002166:Camptothecin