Radical vaginal trachelectomy after laparoscopic staging and neoadjuvant chemotherapy in women with early-stage cervical cancer over 2 cm: oncologic, fertility, and neonatal outcome in a series of 20 patients.
OBJECTIVE
The aim of the study was to assess oncologic and fertility outcome of treatment in patients with cervical cancer of more than 2 cm seeking parenthood.


METHODS
The regimen consisted of laparoscopic lymphadenectomy as a staging procedure to confirm no lymph node metastases before neoadjuvant chemotherapy (NACT) consisting of 2 or 3 cycles of paclitaxel/ifosfamide/cisplatin followed by radical vaginal trachelectomy (RVT). Oncologic and fertility outcome was evaluated prospectively.


RESULTS
Twenty women were enrolled up to now. The mean age was 32 years (range, 26-41 years), and mean tumor size was 3 cm (range, 2.1-5.0 cm). Lymphadenectomy was performed before NACT without complications. During NACT, hematologic toxicity grade 3 was observed in 2 of 20 patients, and renal toxicity grade 3 in 1 of 20 patients. Radical vaginal trachelectomy was performed in 18 women until now with 2 intraoperative complications (ureter injury and injury of internal iliac vein). There were no severe postoperative or long-term complications. Complete pathologic remission was found in 9 of 18 patients. In 2 of 18 patients, chemoradiation was recommended because of insufficient pathologic response in the RVT specimen. After a mean follow-up of 23 months (range, 1-88 months), 1 relapse was observed. After RVT, 7 women tried to conceive until now. Seven pregnancies occurred in 5 women. Four children were born, 2 of whom were premature (31 weeks 2 days and 33 weeks 4 days of gestation); 1 pregnancy is ongoing.


CONCLUSIONS
Laparoscopic lymphadenectomy followed by NACT and RVT in pN0 patients with cervical cancer of more than 2 cm seems to be an oncologically safe procedure with promising fertility outcomes.
*Department of Gynecology, Charité Universitätsmedizin, Berlin, Germany; and †Department of Gynecology, King Saud University Medical College, Riyadh, Saudi Arabia.
Malgorzata
M
Lanowska
Mandy
M
Mangler
Dorothee
D
Speiser
Caroline
C
Bockholdt
Achim
A
Schneider
Christhardt
C
Köhler
Jekaterina
J
Vasiljeva
Malak
M
Al-Hakeem
Giuseppe F
GF
Vercellino
D000230:Adenocarcinoma / Q000188:drug therapy / Q000601:surgery*; D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D005260:Female; D005298:Fertility; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D020360:Neoadjuvant Therapy; D059351:Organ Sparing Treatments; D011247:Pregnancy; D011256:Pregnancy Outcome; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy / Q000601:surgery*
D000970:Antineoplastic Agents