title: Clear cell adenocarcinoma of the female genital tract: long-term outcome and fertility aspects after brachytherapy aimed at a conservative treatment.
abstract: OBJECTIVE
  To assess the outcome and the fertility aspects in the particular population of cervical and/or vaginal clear cell adenocarcinoma (CCA) associated or not to previous in utero diethylstilbestrol exposure.
  
  
  METHODS
  From January 1970 to December 2003, data from 61 consecutive patients with cervical and/or vaginal histologically proven CCA treated with brachytherapy (BT) aimed at a conservative treatment at the Institut Gustave Roussy as a part of treatment were retrospectively analyzed.
  
  
  RESULTS
  The median follow-up was 9.4 years, ranging from 0.3 to 27.4 years. The 5-year specific overall survival rate was 79%. The median time of disease-free survival was 5.8 years. In the subgroup of 42 patients with a cervical CCA, 12 patients tried to be pregnant, 2 patients became pregnant and had miscarriages (P2M2 and P1M1). No pregnancy has been observed in 10 patients exclusively owing to anomalies of the reproductive tract: 6 patients had partial or total diaphragm, 2 patients had an anatomical alteration of the uterus, 1 patient had atrophic endometrium, and 1 patient had primary infertility. In the subgroup of 19 patients with a vaginal CCA, 7 patients tried to be pregnant. All of them had no morphological and/or functional anomalies of the genital tract. Three of 7 patients had delivered healthy babies (P1D1, P2D2, and P3M2D1), and another one had a miscarriage (P1M1). Moreover, all babies were delivered by cesarean section. The pregnancy rate was 10% (6 of 61 patients) with 3 healthy babies.
  
  
  CONCLUSIONS
  Conservative approach in patients with female genital tract CCA including BT gives good results with good survival rates and an interesting global pregnancy rate.
authors.affiliation: Department of Radiotherapy, Brachytherapy Service, Institut Gustave Roussy, Villejuif, France. nicolas.magne@icloire.fr
authors.forename: Nicolas
authors.initials: N
authors.lastname: Magné
authors.forename: Cyrus
authors.initials: C
authors.lastname: Chargari
authors.forename: Antonin
authors.initials: A
authors.lastname: Levy
authors.forename: Carlos
authors.initials: C
authors.lastname: Rodriguez
authors.forename: Véronique
authors.initials: V
authors.lastname: De Vos
authors.forename: Alain
authors.initials: A
authors.lastname: Gerbaulet
authors.forename: Pierre
authors.initials: P
authors.lastname: Duvillard
authors.forename: Philippe
authors.initials: P
authors.lastname: Morice
authors.forename: Christine
authors.initials: C
authors.lastname: Haie-Meder
mesh_terms: D018262:Adenocarcinoma, Clear Cell / Q000401:mortality* / Q000532:radiotherapy; D000293:Adolescent; D000328:Adult; D001918:Brachytherapy; D002648:Child; D005260:Female; D059247:Fertility Preservation; D005500:Follow-Up Studies; D006801:Humans; D009367:Neoplasm Staging; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000401:mortality* / Q000532:radiotherapy; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D002583:Uterine Cervical Neoplasms / Q000401:mortality* / Q000532:radiotherapy; D014625:Vaginal Neoplasms / Q000401:mortality* / Q000532:radiotherapy; D055815:Young Adult