title: Oncological and pregnancy outcomes after high-dose density neoadjuvant chemotherapy and fertility-sparing surgery in cervical cancer.
abstract: OBJECTIVE
  28 women under 35years with early-stage cervical cancer and strong desire for fertility preservation that do not fulfil standard criteria for fertility-sparing surgery (tumour larger than 2cm or with deep of infiltration more than half of stroma) were included in prospective study.
  
  
  METHODS
  Dose-dense neoadjuvant chemotherapy (NAC) was performed on all 28 patients in 10-day intervals: cisplatin plus ifosfamide in squamous cell cancer (15 women-53.6%) or cisplatin plus doxorubicin in adenocarcinoma (13 women-46.3%). Patients underwent laparoscopic lymphadenectomy and vaginal simple trachelectomy after NAC. Patients with positive lymph nodes or inadequate free surgical margins underwent radical hysterectomy.
  
  
  RESULTS
  No residual disease was found in 6 women (21.4%), microscopic disease was observed in 11 women (39.3%) and macroscopic tumour in was observed in 11 women (39.3%). Ten women (35.7%) lost fertility. Four women (20%) after fertility-sparing surgery recurred, two died of the disease (10%). Fertility was spared in 20 (71.4%) women and 10 of them became pregnant (50%). Eight women delivered ten babies (6 term and four preterm deliveries). There were two miscarriages in second trimester (in one woman) and one in first trimester. One woman underwent four unsuccessful cycles of IVF, one failed to become pregnant and one recurred too early. Two women underwent chemoradiotherapy for recurrence and lost chance for pregnancy.
  
  
  CONCLUSIONS
  Downstaging by NAC in IB1 and IB2 cervical cancer before fertility-sparing surgery is still an experimental procedure, but shows some promise. Long-term results in relation to oncological outcome for this concept are still needed.
authors.affiliation: Department of Obstetrics and Gynecology, 2nd Medical Faculty Charles University Prague, Czech Republic.
authors.forename: Helena
authors.initials: H
authors.lastname: Robova
authors.affiliation: Department of Obstetrics and Gynecology, 2nd Medical Faculty Charles University Prague, Czech Republic.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Halaska
authors.affiliation: Department of Obstetrics and Gynecology, 2nd Medical Faculty Charles University Prague, Czech Republic.
authors.forename: Marek
authors.initials: M
authors.lastname: Pluta
authors.affiliation: Department of Pathology and Molecular Medicine, 2nd Medical Faculty Charles University Prague, Czech Republic.
authors.forename: Petr
authors.initials: P
authors.lastname: Skapa
authors.affiliation: Department of Obstetrics and Gynecology, 2nd Medical Faculty Charles University Prague, Czech Republic.
authors.forename: Jan
authors.initials: J
authors.lastname: Matecha
authors.affiliation: Department of Radiology, 2nd Medical Faculty Charles University Prague, Czech Republic.
authors.forename: Jiri
authors.initials: J
authors.lastname: Lisy
authors.affiliation: Department of Obstetrics and Gynecology, 2nd Medical Faculty Charles University Prague, Czech Republic. Electronic address: lukas.rob@lfmotol.cuni.cz.
authors.forename: Lukas
authors.initials: L
authors.lastname: Rob
mesh_terms: D000022:Abortion, Spontaneous / Q000453:epidemiology; D000230:Adenocarcinoma / Q000188:drug therapy* / Q000473:pathology; D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000473:pathology; D002584:Cervix Uteri / Q000473:pathology / Q000601:surgery*; D002945:Cisplatin / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D059247:Fertility Preservation / Q000379:methods*; D006801:Humans; D007044:Hysterectomy; D007069:Ifosfamide / Q000008:administration & dosage; D007247:Infertility, Female / Q000453:epidemiology; D008197:Lymph Node Excision; D020360:Neoadjuvant Therapy / Q000379:methods*; D009367:Neoplasm Staging; D018365:Neoplasm, Residual; D059351:Organ Sparing Treatments / Q000379:methods*; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D047928:Premature Birth / Q000453:epidemiology; D011446:Prospective Studies; D047929:Term Birth; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy* / Q000473:pathology; D055815:Young Adult
chemical_list: D004317:Doxorubicin; D002945:Cisplatin; D007069:Ifosfamide
keywords: Cervical cancer; Fertility outcome; Fertility-sparing surgery; Neoadjuvant chemotherapy; Pregnancy outcome; Trachelectomy