Obstetric Outcomes in Women With Early Bulky Cervical Cancer Downstaged by Neoadjuvant Chemotherapy to Allow for Fertility-Sparing Surgery: A Meta-analysis and Metaregression

Laios, Alexandros; Kasius, Jenneke C.; Tranoulis, Anastasios; Gryparis, Alexandros; Ind, Thomas

doi:10.1097/igc.0000000000001232

Cited by 12 publications

(5 citation statements)

References 47 publications

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“…These results are similar to the results of our review. Unfortunately, in previous reviews33 34 patients with tumors >4 cm (FIGO 2018 stage IB3) were not analyzed as a separate sub-group. Lymphadenectomy prior to chemotherapy could select a proportion of patients with lymph node disease not detected in the images and reduce the number of women eligible for fertility preservation.…”

Section: Discussionmentioning

confidence: 99%

Fertility-sparing surgery after neo-adjuvant chemotherapy in women with cervical cancer larger than 4 cm: a systematic review

Viveros‐Carreño

Rodriguez

Pereira

et al. 2022

Int J Gynecol Cancer

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ObjectiveThe objective of this systematic review was to assess the oncologic and fertility outcomes of patients with cervix-confined cancer >4 cm who underwent neo-adjuvant chemotherapy followed by fertility-sparing surgery.MethodsThis study was registered in PROSPERO (registration number CRD42021254816). PubMed/MEDLINE, ClinicalTrials, EMBASE, Cochrane Central Register of Controlled Trials, SCOPUS, and OVID databases were searched from inception to July 2021. The included patients were those with cancer confined to the cervix and tumor diameter >4 cm (International Federation of Gynecology and Obstetrics (FIGO) 2018 stage IB3) with squamous cell carcinoma, adenocarcinoma, or adenosquamous carcinoma who underwent intra-venous neo-adjuvant chemotherapy followed by successful fertility-sparing surgery.ResultsThe initial search identified 2990 articles. A total of 40 patients from 11 studies had attempted fertility preservation surgery (conization, simple or radical trachelectomy) and in 26 patients (65%) it was successful. All patients received platinum-based chemotherapy. A complete pathological response occurred in 56% of patients and two patients (7.7%) had a recurrence. The 4.5-year disease-free survival was 92.3% and the 4.5-year overall survival rate was 100%. Of six patients who tried to conceive, four (67%) achieved at least one pregnancy and three of the five pregnancies (60%) were pre-term deliveries (all after radical trachelectomy). All patients with recurrence received cisplatin and ifosfamide instead of cisplatin and paclitaxel, underwent non-radical surgery, and had residual disease in the final specimen.ConclusionsEvidence for fertility-sparing surgery after neo-adjuvant chemotherapy in patients with cervical cancer and tumors >4 cm is limited, and this approach should be considered as an experimental intervention. As the use of non-radical surgery could be a risk factor, if neo-adjuvant chemotherapy is used, patients should undergo fertility-sparing radical surgery.

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Section: Discussionmentioning

confidence: 99%

Fertility-sparing surgery after neo-adjuvant chemotherapy in women with cervical cancer larger than 4 cm: a systematic review

Viveros‐Carreño

Rodriguez

Pereira

et al. 2022

Int J Gynecol Cancer

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“…Young people, due to their tendency to maintain pregnancy, are more likely to have surgery, despite the possible need for adjuvant radiotherapy, which is not possible in the case of large tumors. Adjuvant radiotherapy in the patients who are applicable for surgery may help to shrink tumor size and improve response, based on tumor characteristics (21)(22)(23).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Three- and Five-Year Disease-Free Survival in Patients With Cervical Cancer With Spinal Cord Metastasis Under Treatment With External Radiotherapy + Brachytherapy

Charsouei,

Mahdavi,

Nasseri

2022

International Journal of Women’s Health and Reproduction Scienc

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Objectives: In developing countries, treatment of cervical cancer with metastasis to the spinal cord is generally associated with failure and reduced patient survival due to the lack of appropriate facilities. Oncologists are using a variety of methods to prolong patient survival. In the present study, we aimed to estimate the three- and five-year disease-free survival of patients with cervical cancer and spinal cord metastasis, treated with external radiotherapy + brachytherapy (i.e., internal radiotherapy. Materials and Methods: This descriptive cross-sectional study was performed over a period of ten years (2010-20) in the brachytherapy ward of Shahid Madani Hospital (Tabriz, Iran). Overall, 200 patients with cervical cancer and spinal cord metastasis who were candidates for external radiotherapy + brachytherapy were recruited by the census sampling method. The variables that were likely to affect survival were recorded and analyzed using the Koch survival test and relevant descriptive and inferential statistics in SPSS version 23 software. Results: The patients’ overall survival was 43.12 ± 1.44 months; 78 patients (39%) survived until the end of the third year, and 49 (24.5%) lived till the end of the fifth year. Also, the pathological diagnosis (P=0.013- P=0.015), disease stage (P=0.014- P=0.018), the length of the treatment area (P=0.026- P=0.044), and undergoing chemotherapy (P=0.001- P=0.002) were significantly associated with the survival of the patients who completed the treatment course. Conclusions: Chemotherapy, advanced disease, and greater length of the treatment area reduced three- and five-year survival in the patients with cervical cancer and spinal cord metastasis who underwent brachytherapy.

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“…4 Approximately 40% of the diagnoses of CC are in women younger than 40 years, for whom fertility-sparing treatment might be very important and should always be considered. 5 More than half the patients who undergo radical surgery (trachelectomy or hysterectomy) have no remnant tumor in the final pathology specimen. This suggests that they could presumably benefit from a less radical procedure.…”

mentioning

confidence: 99%

“…In early-stage disease (stages IA–IB2), treatment is usually surgical 4 . Approximately 40% of the diagnoses of CC are in women younger than 40 years, for whom fertility-sparing treatment might be very important and should always be considered 5 . More than half the patients who undergo radical surgery (trachelectomy or hysterectomy) have no remnant tumor in the final pathology specimen.…”

mentioning

confidence: 99%

The Association Between Clearance of Human Papillomavirus After Conization for Cervical Cancer and Absence of Cancer

Siegler

Goldberg

Siegler

et al. 2021

J Low Genit Tract Dis

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Objectives:We assessed the relation between clearance of high-risk human papillomavirus (HR-HPV) after large loop excision of the transformation zone (LLETZ) and absence of residual disease, in women diagnosed with cervical cancer (CC) and adenocarcinoma in situ (AIS).Materials Methods: Data were collected from 92 women diagnosed with CC and AIS who were positive to HR-HPV and had a repeat cervical HPV test 3-12 weeks after LLETZ (in which CC/AIS were diagnosed) and before final surgical treatment. We compared characteristics of women with negative and positive HR-HPV after LLETZ. Results:The HR-HPV results after the LLETZ operation were negative in 40 women and positive in 52 women. The HR-HPV-negative group included a significantly higher incidence of AIS: 14 (35%) vs 5 (9.6%, p < .006). In the negative HR-HPV post-LLETZ group, 36 (90%) had normal histology and only 2 (5%) had cancer in the final histological specimen. Among 34 women who underwent radical hysterectomy/trachelectomy after LLETZ, a normal final histology was observed in 75% and 9% of those who were HR-HPV negative and HR-HPV positive, respectively (p < .0005). The positive predictive value for absence of residual cancer, with clearance of HR-HPV after LLETZ, was 95%.Conclusions: Clearance of HR-HPV from the cervix a short time after LLETZ has a high association with the absence of residual cancer in the final outcome, either in the pathology or the follow-up. Testing for HR-HPV a short time after LLETZ might serve as a parameter for risk assessment.

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Obstetric Outcomes in Women With Early Bulky Cervical Cancer Downstaged by Neoadjuvant Chemotherapy to Allow for Fertility-Sparing Surgery: A Meta-analysis and Metaregression

Abstract: This strategy achieves live births in four of 10 eCC women who desire fertility, whereas their risk of miscarriage is low. Three of 10 live births will be premature.

Cited by 12 publications

References 47 publications

Fertility-sparing surgery after neo-adjuvant chemotherapy in women with cervical cancer larger than 4 cm: a systematic review

Fertility-sparing surgery after neo-adjuvant chemotherapy in women with cervical cancer larger than 4 cm: a systematic review

Evaluation of Three- and Five-Year Disease-Free Survival in Patients With Cervical Cancer With Spinal Cord Metastasis Under Treatment With External Radiotherapy + Brachytherapy

The Association Between Clearance of Human Papillomavirus After Conization for Cervical Cancer and Absence of Cancer

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