title: Review of neoadjuvant chemotherapy and trachelectomy: which cervical cancer patients would be suitable for neoadjuvant chemotherapy followed by fertility-sparing surgery?
abstract: The number of patients given neoadjuvant chemotherapy (NAC) followed by fertility-sparing surgery in cervical cancer is still scarce. Only a few centres perform these procedures, and thus, such procedures remain largely in the experimental stage. Patients that do not fulfil the criteria for standard fertility-sparing procedure can be included in studies with NAC followed by fertility-sparing procedure. We must consider that both oncological and pregnancy outcomes are important. Patients with only microscopic disease after NAC are apparently the best candidates for fertility-sparing surgery. Current data are not sufficient to identify the optimal procedure after NAC [abdominal radical trachelectomy (ART) or vaginal radical trachelectomy (VRT) or simple trachelectomy]. Some evidence suggests that pregnancy outcome is better after simple trachelectomy as compared with VRT or ART. Long-term results regarding oncological outcome for this concept are still lacking. Adjuvant chemotherapy in patients with histopathological risk factors (lymphovascular space involvement (LVSI), macroscopic residual disease) would decrease a risk of recurrence.
authors.affiliation: Department of Obstetrics and Gynecology, 2nd Medical Faculty, Charles University, V Uvalu 84, 150 00, Prague 5, Czech Republic, helena.robova@fnmotol.cz.
authors.forename: Helena
authors.initials: H
authors.lastname: Robova
authors.forename: Lukas
authors.initials: L
authors.lastname: Rob
authors.forename: Michael Jiri
authors.initials: MJ
authors.lastname: Halaska
authors.forename: Marek
authors.initials: M
authors.lastname: Pluta
authors.forename: Petr
authors.initials: P
authors.lastname: Skapa
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000601:surgery; D003131:Combined Modality Therapy; D005260:Female; D059247:Fertility Preservation / Q000379:methods*; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D008279:Magnetic Resonance Imaging; D020360:Neoadjuvant Therapy / Q000379:methods*; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D011247:Pregnancy; D011256:Pregnancy Outcome; D021701:Sentinel Lymph Node Biopsy; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000473:pathology* / Q000601:surgery