title: Fertility-sparing surgery for the management of young women with embryonal rhabdomyosarcoma of the cervix: A case series.
abstract: OBJECTIVE
  To report three cases of embryonal rhabdomyosarcoma (ERMS) of the cervix in young women successfully treated with fertility-sparing surgery and chemotherapy.
  
  
  METHODS
  Between January 2014 and December 2015, three cases of ERMS of the cervix were confirmed in young women at a single tertiary cancer center. All cases were managed by a pediatric oncologist and a gynecologic oncologist with a combination of surgery and chemotherapy. Fertility-sparing surgeries (cervical conization or robotic-assisted radical trachelectomy) were offered to patients depending on the tumor size.
  
  
  RESULTS
  All patients were nulliparous and aged 14, 20 and 21 years and all presented with abnormal uterine bleeding. The first patient was managed with radical trachelectomy followed by adjuvant chemotherapy. The second patient underwent primary hysteroscopic resection of the tumor followed by completion cervical conization and adjuvant chemotherapy. The third patient received neoadjuvant chemotherapy followed by loop electrosurgical excision procedure (LEEP) with positive residual margins. She then underwent completion radical trachelectomy. None of the patients experienced perioperative complications. None of the women received radiation. All patients are alive with no evidence of disease.
  
  
  CONCLUSIONS
  Fertility-sparing surgery and chemotherapy in well-selected patients with ERMS of the cervix result in low complication rates and excellent oncologic outcomes. This treatment option may be considered in young patients who wish to preserve fertility by avoiding hysterectomy. A collaborative effort between pediatric oncologists and gynecologic oncologists is imperative to facilitate innovative approaches to these rare tumors in young adults.
authors.affiliation: Division of Gynecologic Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada.
authors.forename: Geneviève
authors.initials: G
authors.lastname: Bouchard-Fortier
authors.affiliation: Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada.
authors.forename: Raymond H
authors.initials: RH
authors.lastname: Kim
authors.affiliation: Division of Pediatric Gynecology, Hospital for Sick Children, University of Toronto, Toronto, Canada.
authors.forename: Lisa
authors.initials: L
authors.lastname: Allen
authors.affiliation: Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada; Division of Pediatric Gynecology, Hospital for Sick Children, University of Toronto, Toronto, Canada.
authors.forename: Abha
authors.initials: A
authors.lastname: Gupta
authors.affiliation: Division of Gynecologic Oncology, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Canada.
authors.forename: Taymaa
authors.initials: T
authors.lastname: May
keywords: Embryonal rhabdomyosarcoma; Fertility-sparing surgery; Radical trachelectomy; Sarcoma botryoides