Fertility-sparing options for early stage cervical cancer

To review the literature on fertility-sparing options for women with early stage cervical cancer and outline patient selection criteria, operative, oncologic, and pregnancy outcomes.

The literature was searched using MEDLINE (OVID: 1950 through October 2009) and EMBASE (OVID: 1988 through October 2009) using combined disease-specific terms (uterine cervix neoplasms/ or cervi:.ti AND cancer:.ti or neoplasms/ or carcinoma:.ti) with treatment-specific term (trachelectomy/). The search was restricted to English or French language and humans. Additionally, Pubmed was searched with terms "cervix", "carcinoma", and "trachelectomy". Reference lists of related articles and recent review articles were also screened for additional citations.

The largest data on fertility-sparing procedures in early stage cervical cancer has been reported with radical vaginal trachelectomy (RVT). Other fertility-sparing options have emerged recently, such as radical abdominal trachelectomy (RAT). There have been reports of more conservative methods such as simple trachelectomy or cone biopsy, with or without neoadjuvant chemotherapy.

RVT is now well established as a safe and feasible procedure for this patient population, with low morbidity, recurrence, and mortality rates. The use of RAT in selected patients has increased, in addition to more conservative methods such as simple trachelectomy or cone biopsy, with or without neoadjuvant chemotherapy. Continued research in these areas will determine the safety and feasibility of these potential procedures, which will help give more treatment options for young women with early stage cervical cancers.