TREATMENT OPTION TO THE FERTILITY-SPARING RADICAL TRACHELECTOMY AFTER NEOADJUVANT CHEMOTHERAPY IN PATIENTS WITH CERVICAL CANCER WITH TUMOR SIZE >2CM

Authors

  • A. Shipko National Cancer Institute, Ministry of Health of Ukraine
  • O. Renkas National Cancer Institute, Ministry of Health of Ukraine
  • V. Svintsitskyi National Cancer Institute, Ministry of Health of Ukraine
  • V. Pryimak National Cancer Institute, Ministry of Health of Ukraine
  • O. Movchan National Cancer Institute, Ministry of Health of Ukraine

DOI:

https://doi.org/10.32471/exp-oncology.2312-8852.vol-44-no-3.18350

Keywords:

cervical cancer, fertility-sparing surgery, neoadjuvant chemotherapy, radical vaginal trachelectomy

Abstract

Radical trachelectomy combined with pelvic lymphadenectomy (PLND) has been used to treat early stage cervical cancer patients who wish to preserve their fertility. But vaginal, abdominal, laparoscopic, and robotic approaches used for radical trachelectomy with pelvic PLND cause peritoneal damage, which could result in periadnexal adhesion. Here, we propose the neoadjuvant platinum based chemotherapy (NACT) with the vaginal radical trachelectomy with retroperitoneal PLND as a fertility-preserving option for early stage cervical cancer patients. VRT with retroperitoneal PLND was performed in three women with FIGO 2018 stage IB2 and IIA1 cervical cancers. In all three patients, complete response was achieved without causing any intraoperative and severe postoperative complications. NACT for fertility sparing treatment is an innovative approach, which is potentially quite interesting for many young women affected by cervical cancer with the tumor size >2 cm. Vaginal radical trachelectomy with retroperitoneal PLND can be safely performed and peritoneal damage, which can cause periadnexal adhesion, could be avoided. We consider that this surgical approach and NACT may be a good treatment option for women with cervical cancer who wish to preserve their fertility.

References

Fedorenko Z, Michailovich Yu, Goulak L, et al. Bulletin of the National Cancer Registry of Ukraine. 2021; 22: 44–5. Available at http://www.ncru.inf.ua/publications/BULL_22/index_e.htm

NCCN Guidelines Version 1.2022 Cervical cancer. doi: https:/www.nccn.org

Marchiol P, Ferraioli D, Moran E, et al. NACT and laparoscopic-assisted radical vaginal trachelectomy in young patients with large (2-5 cm) high risk cervical cancers: safety and obstetrical outcome. Surg Oncol 2018; 27: 236–44. https://doi.org/10.1016/j.suronc.2018.04.006

Robova H, Halaska MJ, Pluta M, et al. Oncological and pregnancy outcomes after high-dose density neoadjuvant chemotherapy and fertility-sparing surgery in cervical cancer. Gynecol Oncol 2014; 135: 213–6. https://doi.org/10.1016/j.ygyno.2014.08.021

Lanowska M, Mangler M, Speiser D, et al. Radical vaginal trachelectomy after laparoscopic staging and neoadjuvant chemotherapy in women with early-stage cervical cancer over 2 cm: oncologic, fertility, and neonatal outcome in a series of 20 patients. Int J Gynecol Cancer 2014; 24: 586–93. https://doi.org/10.1097/IGC.0000000000000080

Lu Q, Zhang Y, Wang S, et al. Neoadjuvant intraarterial chemotherapy followed by total laparoscopic radical trachelectomy in stage IB1 cervical cancer. Fertil Steril 2014; 101: 812–7. https://doi.org/10.1016/j.fertnstert.2013.12.001

Vercellino GF, Piek JMJ, Schneider A, et al. Laparoscopic lymph node dissection should be performed before fertility preserving treatment of patients with cervical cancer. Gynecol Oncol 2012; 126: 325–9. https://doi.org/10.1016/j.ygyno.2012.05.033

Guo J, Zhang Y, Chen X, et al. Surgical and oncologic outcomes of radical abdominal trachelectomy versus hysterectomy for stage IA2-IB1 cervical cancer. J Minim Invasive Gynecol 2019; 26: 484–91. https://doi.org/10.1016/j.jmig.2018.06.006

Deng X, Zhang Y, Li D, et al. Abdominal radical trachelectomy guided by sentinel lymph node biopsy for stage IB1 cervical cancer with tumors >2. Oncotarget 2017; 8: 3422–9. https://doi.org/10.18632/oncotarget.13788

Boss EA, van Golde RJ, Beerendonk CC, et al. Pregnancy after radical trachelectomy: a real option? Gynecol Oncol 2005; 99: 152–6. https://doi.org/10.1016/j.ygyno.2005.07.071

Pareja R, Rendoґn GJ, Sanz-Lomana CM, et al. Surgical, oncological, and obstetrical outcomes after abdominal radical trachelectomy. Systematic literature review. Gynecol Oncol 2013; 131: 77–82. https://doi.org/10.1016/j.ygyno.2013.06.010

Johansen G, LoЁnnerfors C, Falconer H, et al. Reproductive and oncologic outcome following robot-assisted laparoscopic radical trachelectomy for early stage cervical cancer. Gynecol Oncol 2016; 141: 160–5. https://doi.org/10.1016/j.ygyno.2016.01.028

Vasilev SA. A modified incision and technique for total retroperitoneal access and lymph node dissection. Gynecol Oncol 1995; 56: 226–30. https://doi.org/10.1006/gyno.1995.1036

Massi G, Susini T, Amunni G. Extraperitoneal pelvic lymphadenectomy to complement vaginal operations for cervical and endometrial cancer. Int J Gynaecol Obstet 2000; 69: 27–35. https://doi.org/10.1016/s0020-7292(99)00227-1

Eisenhauer EA, Therasse P, Bogaerts J, et al. New response evaluationcriteria in solid tumors: revised RECIST guideline (version1.1). Eur J Cancer 2009; 45: 228–47. https://doi.org/10.1016/j.ejca.2008.10.026

Bhatla N, Aoki D, Sharma DN, et al. Cancer of the cervix uteri. Int J Gynecol Obstet 2018; 143: 22–36. https://doi.org/10.1002/ijgo.12611

Landoni F, Maneo A, Colombo A, et al. Randomised study of radical surgery versus radiotherapy for stage Ib-IIa cervical cancer. Lancet 1997; 23: 535–40. https://doi.org/10.1016/S0140-6736(97)02250-2

van Kol KGG, Vergeldt TFM, Bekkers RLM. Abdominal radical trachelectomy versus chemotherapy followed by vaginal radical trachelectomy in stage 1B2 (FIGO 2018) cervical cancer. A systematic review on fertility and recurrence rates. Gynecol Oncol 2019; 155: 515–21. https://doi.org/10.1016/j.ygyno.2019.09.025

Krielen P, Stommel MWJ, Pargmae P, et al. Adhesion-related readmissions after open and laparoscopic surgery: a retrospective cohort study (SCAR update). Lancet 2020; 395: 33–41. https://doi.org/10.1016/S0140-6736(19)32636-4

Milingos S , Kallipolitis G, Loutradis D, et al. Adhesions: laparoscopic surgery versus laparotomy. Ann NY Acad Sci. 2000; 900: 272–85. https://doi.org/10.1111/j.1749-6632.2000.tb06239.x

Molinas CR, Binda MM, Manavella GD, et al. Adhesion formation after laparoscopic surgery: what do we know about the role of the peritoneal environment? Facts Views Vis Obgyn. 2010; 2: 149–60. doi: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4090584

Lower AM, Hawthorn RJ, Clark D, et al. Adhesion-related readmissions following gynaecological laparoscopy or laparotomy in Scotland: an epidemiological study of 24 046 patients. Hum Reprod 2004; 19: 1877–85. https://doi.org/10.1093/humrep/deh321

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Published

26.05.2023

How to Cite

Shipko, A., Renkas, O., Svintsitskyi, V., Pryimak, V., & Movchan, O. (2023). TREATMENT OPTION TO THE FERTILITY-SPARING RADICAL TRACHELECTOMY AFTER NEOADJUVANT CHEMOTHERAPY IN PATIENTS WITH CERVICAL CANCER WITH TUMOR SIZE >2CM. Experimental Oncology, 44(3), 254–258. https://doi.org/10.32471/exp-oncology.2312-8852.vol-44-no-3.18350

Issue

Vol. 44 No. 3 (2022): Experimental Oncology

Section

Case report

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