Outcomes of fertility and pregnancy in patients with early-stage cervical cancer after undergoing neoadjuvant chemotherapy

Objective: To explore the outcomes of oncology, fertility, and pregnancy in patients after undergoing neoadjuvant chemotherapy (NACT) followed by fertility-sparing operations with cervical cancer, and its value in clinical treatment. Materials and Methods: A total of 11 patients from seven hospitals in Beijing with cervical cancer since August 2009 to December 2011, who had undergone fertilitysparing treatments were recruited in this study. Results: Among the 11 patients, there were nine cases of squamous cell carcinoma, two cases of adenocarcinoma, one case in Stage IA2, and ten cases in Stage IB1 (FIGO, 2009). All of the 11 patients were treated with NACT of one to two cycles before the operations, and then they underwent radical trachelectomy (RT) + retroperitoneal lymphadenectomy. Eleven patients had completed the follow-up (100%) and the mean follow-up was 24.4 months. The outcomes of the oncology and pregnancy are as follows: no patient recurred after fertility-sparing treatments; in seven patients seeking pregnancy after the treatments, three pregnancies occurred in two women. Conclusions: NACT+RT, as a fertility-sparing treatment for young women with bulky early-stage cervical cancer and its outcomes in fertility and pregnancy are satisfactory, however its safety needs to be studied further.

Early-stage cervical cancer; Neoadjuvant chemotherapy; Fertility-sparing; Pregnancy.

[1] Covens A., Rosen B., Murphy J., Laframboise S., DePetrillo A.D., Lickrish G., et al.: “Changes in the demographics and perioperative care of stage IA(2)/IB(1) cervical cancer over the past 16 years”. Gy-necol. Oncol., 2001, 81, 133.

[2] Corney R.H, Crowther M.E., Everett H., Howells A., Shepherd J.H.: “Psychosexual dysfunction in women with gynaecological cancer following radical pelvic surgery”. Br. J. Obstet. Gynaecol., 1993, 100, 73.

[3] Alexander-Sefre F., Chee N., Spencer C., Menon U., Shepherd J.H.: “Surgical morbidity associated with radical trachelectomy and radical hysterectomy”. Gynecol. Oncol., 2006, 101, 450.

[4] Smith J.R., Boyle D.C., Corless D.J., Ungar L., Lawson A.D., Del P. G., et al.: “Abdominal radical trachelectomy: a new surgical technique for the conservative management of cervical carcinoma”. Br. J. Obstet. Gynaecol., 1997, 104, 1196.

[5] Plante M., Lau S., Brydon L., Swenerton K., LeBlanc R., Roy M.: “Neoadjuvant chemotherapy followed by vaginal radical trachelectomy in bulky stage IB1 cervical cancer: case report”. Gynecol. Oncol., 2006, 101, 367.

[6] Robova H., Pluta M., Hrehorcak M., Skapa P., Rob L.: “High-dose density chemotherapy followed by simple trachelectomy: fullterm pregnancy”. Int. J. Gynecol. Cancer, 2008, 18, 1367.

[7] Landoni F., Parma G., Peiretti M., Zanagnolo V., Sideri M., Colombo N., et al.: “Chemo-conization in early cervical cancer”. Gynecol. Oncol., 2007, 107, S125.

[8] Landoni F., Parma G., Peiretti M., Zanagnolo V., Sideri M., Colombo N., et al.: “Chemo-conization in early cervical cancer”. Gynecol. Oncol., 2007, 107, S125.

[9] Rob L., Charvat M., Robova H., Pluta M., Strnad P., Hrehorcak M., et al.: “Less radical fertility-sparing surgery than radical trachelectomy in early cervical cancer”. Int. J. Gynecol. Cancer, 2007, 17, 304.

[10] World Health Organization: “WHO Handbook for reporting results for cancer treatment criteria”. Geneva, 1979. Available at: http://whqlibdoc.who.int/offset/WHO_OFFSET_48.pdf

[11] Maneo A., Chiari S., Bonazzi C., Mangioni C.: “Neoadjuvant chemotherapy and conservative surgery for stage IB1 cervical cancer”. Gynecol. Oncol., 2008, 111, 438.

[12] Robova H., Halaska M., Pluta M., Skapa P., Strnad P., Lisy J., et al.: “The role of neoadjuvant chemotherapy and surgery in cervical cancer”. Int. J. Gynecol. Cancer, 2010, 20, S42.

[13] Gottschalk E., Mangler M., Schneider A., Koehler C., Lanowska M.: “Pregnancy after lymphadenectomy and neoadjuvant chemotherapy followed by radical vaginal trachelectomy in FIGO stage IB1 cervical cancer”. Fertil. Steril., 2011, 95, 2431.

[14] Marchiole P., Tigaud J.D., Costantini S., Mammoliti S., Buenerd A., Moran E., et al.: “Neoadjuvant chemotherapy and vaginal radical trachelectomy for fertility-sparing treatment in women affected by cervical cancer (FIGO stage IB-IIA1)”. Gynecol. Oncol., 2011, 122, 484.

[15] Bader A.A., Petru E., Winter R.: “Long-term follow-up after neoadjuvant chemotherapy for high-risk cervical cancer during pregnancy”. Gynecol. Oncol., 2007, 105, 269.

[16] Roy M., Plante M.: “Pregnancies after radical vaginal trachelectomy for early-stage cervical cancer”. Am. J. Obstet. Gynecol., 1998, 179, 1491.

[17] Beiner M.E., Covens A.: “Surgery insight: radical vaginal trachelectomy as a method of fertility preservation for cervical cancer”. Nat. Clin. Pract. Oncol., 2007, 4, 353.

[18] Rob L., Skapa P., Robova H.: “Fertility-sparing surgery in patients with cervical cancer”. Lancet Oncol., 2011, 12, 192.