Neoadjuvant chemotherapy and vaginal radical trachelectomy for fertility-sparing treatment in women affected by cervical cancer (FIGO stage IB–IIA1)

ObjectivesThe aim of the present report is to support the feasibility and the safety of a new fertility-sparing treatment in young women affected by bulky cervical cancer.MethodsBetween February 2007 and October 2010, seven patients presenting large IB–IIA1 tumors (30–45 mm) were scheduled for conservative treatment. All patients underwent neoadjuvant chemotherapy (NACT) followed by laparoscopic pelvic lymphadenectomy and vaginal radical trachelectomy (VRT).ResultsOne patient presented hematological toxicity during NACT (grade 3). All patients showed complete disappearance of tumor (n = 4/7) or partial response (a 50% or more decrease in total tumor size, n = 3/7) to neoadjuvant treatment, and they were all treated with pelvic lymphadenectomy and VRT. Additional treatment (interstitial brachytherapy) was offered to only one woman because of a persistent parametrial tumoral lesion.After a mean follow up of 22 months (range 5–49), no relapse was observed. To date, only one woman in our study attempted to conceive and she is currently pregnant.ConclusionsNeoadjuvant chemotherapy for fertility sparing treatment is an innovative approach which is potentially quite interesting for many young women affected by bulky cervical cancer. These women, i.e. those with tumors larger than 2 cm (2–5 cm), are traditionally not offered fertility sparing treatment, thus the preliminary data we report here might have a promising impact. Nevertheless, for these patients it may be suitable to use the more radical, and time-tested, conservative surgical approach to allow for a complete and conservative excision of the residual tumor after neoadjuvant treatment.Studies with a larger number of patients and adequate follow-up are required to validate this conservative approach and to define clearly the good indications for this treatment.

► NACT gives complete or ≥ 50% response in larger cervical lesions (IB–IIA1 > 2 cm). ► NACT + VRT: possible therapy for large early cervical cancers (IB–IIA1 > 2 cm). ► VRT after NACT: safer than more conservative surgical methods.