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Neoadjuvant chemotherapy followed by large cone resection as fertility-sparing therapy in stage IB cervical cancer.
- Source :
-
Gynecologic oncology [Gynecol Oncol] 2015 Dec; Vol. 139 (3), pp. 447-51. Date of Electronic Publication: 2015 Jun 04. - Publication Year :
- 2015
-
Abstract
- Background: Standard treatment of cervical cancer FIGO stage IB1 is a radical hysterectomy with pelvic lymphadenectomy. As the number of patients with a preserved fertility wish has increased, the need for fertility sparing surgery emerges. In this study we discuss 11 patients with cervical carcinoma stage IB treated with neoadjuvant chemotherapy followed by large cone resection.<br />Methods: In this retrospective study we included 10 patients with FIGO stage IB1 and 1 patient with IB2 cervical cancer, who first received a pelvic lymphadenectomy followed by neoadjuvant chemotherapy and conization. Paclitaxel-ifosfamide-carboplatin or a combination of paclitaxel-carboplatin was used as neoadjuvant chemotherapy.<br />Results: Complete response after chemotherapy was observed in 64%, partial response in 27% and 9% had progressive disease. All patients with response underwent a conization, with no residual disease on pathology in 80%. Patients with residual disease were treated by radical hysterectomy. In 9 patients fertility sparing surgery could be performed and 6 (67%) got pregnant. Five patients had 7 children and two patients had four missed abortions. Two premature deliveries at 32 and 33weeks were described, both in the same patient. Recurrence was observed in one patient that was treated with simple hysterectomy followed by radiochemotherapy. Median follow up time is 58months with all patients alive and no evidence of disease until now.<br />Conclusions: Neoadjuvant chemotherapy followed by conization seems to be a promising new fertility sparing treatment modality in patients with cervical carcinoma stage IB1, but further studies with larger populations should confirm these data.<br /> (Copyright © 2015 Elsevier Inc. All rights reserved.)
- Subjects :
- Abortion, Missed etiology
Adenocarcinoma secondary
Adult
Carboplatin administration & dosage
Carcinoma, Squamous Cell secondary
Chemotherapy, Adjuvant
Cisplatin administration & dosage
Disease Progression
Female
Follow-Up Studies
Humans
Ifosfamide administration & dosage
Lymphatic Metastasis
Neoplasm Staging
Paclitaxel administration & dosage
Pelvis
Pregnancy
Pregnancy Rate
Premature Birth etiology
Retrospective Studies
Treatment Outcome
Tumor Burden
Uterine Cervical Neoplasms pathology
Adenocarcinoma therapy
Antineoplastic Combined Chemotherapy Protocols therapeutic use
Carcinoma, Squamous Cell therapy
Cervix Uteri surgery
Conization
Fertility Preservation
Lymph Node Excision
Neoadjuvant Therapy
Uterine Cervical Neoplasms therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1095-6859
- Volume :
- 139
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- Gynecologic oncology
- Publication Type :
- Academic Journal
- Accession number :
- 26050921
- Full Text :
- https://doi.org/10.1016/j.ygyno.2015.05.043