title: Fertility preservation by photodynamic therapy combined with conization in young patients with early stage cervical cancer: a pilot study.
abstract: BACKGROUND
  Vaginal radical trachelectomy (VRT) is the standard fertility preserving procedure for early stage cervical cancer patients. There have been reports in the literature, however, that VRT to be too radical procedure for early stage cervical cancer, as its post-operative obstetric morbidity was high. In this study, PDT with Loop electrosurgical excision procedure (LEEP) or conization was investigated as a less radical fertility preserving treatment alternative to VRT for early stage cervical cancer patients.
  
  
  METHODS
  We analyzed data of 21 patients with early stage cervical cancer (stages IA-IIA) who underwent PDT with LEEP/conization from 2003 to 2012. LEEP or conization was performed before PDT in every case. For patients in stage IB1 or above, only those who were confirmed to be free of malignancy in frozen section by pelvic lymph node dissection received PDT. Surface photoillumination with red laser light at a wavelength of 630nm was applied to the cervix and the endocervical canal 48h after intravenous injection of 2mg/kg of photosensitizer.
  
  
  RESULTS
  Median age of the 21 patients was 31 years old (range: 22-43), 19 patients (90.5%) of whom were nulliparous. Majority of the lesions were at stage IA1 (47.6%) or IB1 (42.9%). Histologically, 80.9% were squamous cell carcinoma. 5 patients (23.8%) had a lesion of 2cm or larger in diameter. There was one recurrence (4.7%) and no death during 52.6 months (6-114 months). Of the 13 women who attempted to get pregnant, 10 (76.9%) women conceived a total of 11 pregnancies. The first and second trimester miscarriages were 2 and 1 respectively, and 7 (70%) of the pregnancies reached the third trimester, of which 5 delivered at term. No tumor-related deaths or PDT-related severe adverse effects were noted.
  
  
  CONCLUSIONS
  PDT combined with LEEP/conization could be an effective fertility sparing conservative treatment for young patients with early stage cervical cancer.
authors.affiliation: Comprehensive Gynecologic Cancer Center, Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University, Seongnam-si, Gyeonggi-do, South Korea.
authors.forename: Min Chul
authors.initials: MC
authors.lastname: Choi
authors.affiliation: Comprehensive Gynecologic Cancer Center, Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University, Seongnam-si, Gyeonggi-do, South Korea.
authors.forename: Sang Geun
authors.initials: SG
authors.lastname: Jung
authors.affiliation: Comprehensive Gynecologic Cancer Center, Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University, Seongnam-si, Gyeonggi-do, South Korea.
authors.forename: Hyun
authors.initials: H
authors.lastname: Park
authors.affiliation: Comprehensive Gynecologic Cancer Center, Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University, Seongnam-si, Gyeonggi-do, South Korea.
authors.forename: Sun Young
authors.initials: SY
authors.lastname: Lee
authors.affiliation: Comprehensive Gynecologic Cancer Center, Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University, Seongnam-si, Gyeonggi-do, South Korea. Electronic address: chanoncology@chamc.co.kr.
authors.forename: Chan
authors.initials: C
authors.lastname: Lee
authors.affiliation: Comprehensive Gynecologic Cancer Center, Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University, Seongnam-si, Gyeonggi-do, South Korea.
authors.forename: Yeun Young
authors.initials: YY
authors.lastname: Hwang
authors.affiliation: Comprehensive Gynecologic Cancer Center, Department of Obstetrics and Gynecology, CHA Bundang Medical Center, CHA University, Seongnam-si, Gyeonggi-do, South Korea.
authors.forename: Seung Jo
authors.initials: SJ
authors.lastname: Kim
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy / Q000379:methods; D019092:Conization / Q000379:methods*; D005260:Female; D059247:Fertility Preservation / Q000379:methods*; D006801:Humans; D009367:Neoplasm Staging; D010778:Photochemotherapy / Q000379:methods*; D010865:Pilot Projects; D012189:Retrospective Studies; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000628:therapy*; D055815:Young Adult
keywords: Early stage cervical cancer; Fertility preservation; Photodynamic therapy