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Published on: September 12, 2019
Neoadjuvant chemotherapy and conservative surgery for stage IB1 cervical cancer
Andrea Maneo1, Stefania Chiari, Cristina Bonazzi
1Department of Gynecologic Oncology, S Gerardo Hospital, University of Milan Bicocca, Monza, Italy. a.maneo@hsgerardo.org
Objectives:
To assess the effectiveness of chemo-surgical conservative therapy for stage IB1 cervical tumors in patients desiring to preserve fertility.
Methods:
From 1995 to April 2007 51 nulliparous patients with tumor
Results:
Thirty women (59%) did not accept the conservative approach. In the remaining 21 patients median age was 30 years and median tumor size was 15 mm (range 10-30 mm). Adenocarcinoma was present in 12 cases (57%) and indifferentiated neoplasia in 10 (48%). Following neoadjuvant treatment, pathological complete response was observed in 5 cases, in situ or microinvasive residue in 12 and stromal invasion >3 mm in 4. Four women deemed ineligible for conservative surgery after chemotherapy and one refusing to preserve her genital apparatus underwent radical hysterectomy. After a median follow-up of 69 months no relapses were observed. Nine women attempted to conceive: ten pregnancies occurred in 6 patients and 9 live babies have been born, while one woman experienced a first-trimester miscarriage.
Conclusions:
The high rate of pathological response confirms the effectiveness of the preoperative treatment for reducing the tumor volume allowing the removal only of a cervical cone instead of the entire cervix with cardinal ligaments as needed by radical trachelectomy. Successful pregnancies are possible after such integration.