Conservative Treatment of Stage IA1 Adenocarcinoma of the Uterine Cervix With a Long-Term Follow-Up

Yahata, Tetsuro; Nishino, Kazumi; Kashima, Katsunori; Sekiguchi, Masayuki; Fujita, Kazuyuki; Sasagawa, M; Honma, Shiho; Kudoh, Shoji; Tanaka, Kenichi

doi:10.1111/igc.0b013e3181e768b6

Cited by 16 publications

(11 citation statements)

References 15 publications

(9 reference statements)

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“…Extensive treatment such as RH with pelvic lymph node dissection (PLND) or trachelectomy does not prevent recurrence [ 7 ]. Conservative treatment has been studied for decades to preserve fertility in patients with MIC [ 6 , 7 , 14 , 15 , 16 , 17 ]. Some researchers considered conization alone with careful follow-up appears to be an effective and safe treatment for patients with stage IA1 MIC regardless of resection margin status or LVSI [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

Analysis of treatment modalities and prognosis on microinvasive cervical cancer: a 10-year cohort study in China

et al. 2014

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ObjectiveTo explore appropriate treatment modality of microinvasive cervical cancer (MIC) and to analyze prognosis and risk factors of recurrence.MethodsA cohort of 324 Chinese patients with MIC diagnosed and treated at Peking Union Medical College Hospital was retrospectively reviewed. Demographic features, treatment modalities, pathologic parameters, risk factors of residual disease, survival and risk factors of recurrence were analyzed.ResultsOf all patients, 280 cases were staged IA1 and 44 cases staged IA2 MIC. Twenty-five cases (7.7%) were found to have lympho-vascular space involvement (LVSI), but no parametrial involvement or ovarian metastasis was detected. Only one staged IA2 patient with LVSI was found to have lymph node metastasis. 32.4% patients (82/253) had residual diseases after conization. No significant difference of LVSI, lymph node metastasis and residual disease after coniztion was found between stage IA1 and IA2 MIC patients. Multivariate logistic analysis showed positive margin was the only independent risk factor of residual disease after conization (odds ratio [OR], 4.18; p<0.001). Recurrence occurred in five cases, but no mortality was found. Progression-free survival for stage IA1 patients treated by conization or hysterectomy was similar (92.3% and 98.8%, p=0.07). Cox regression analysis revealed LVSI as an independent risk factor for recurrence in stage IA1 patients (OR, 12.14; p=0.01).ConclusionFor stage IA1 patients with negative resection margin and no LVSI, conization can be an ideal treatment modality. For stage IA2 patients, more conservative surgery such as simple hysterectomy may be considered. LVSI is an independent risk factor for recurrence in patients with stage IA1 cervical cancer.

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Section: Introductionmentioning

confidence: 99%

Analysis of treatment modalities and prognosis on microinvasive cervical cancer: a 10-year cohort study in China

et al. 2014

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“…It is well known that the survival after simple total hysterectomy is the same as after radical surgery [31], and there are data about long-term followup after conservative treatment [9, 29]. Only conization or a simple/radical trachelectomy—eventually associated with lymphadenectomy—may be defined as “conservative treatment,” which is to say a fertility-sparing treatment.…”

Section: Discussionmentioning

confidence: 99%

“…The large presence of cytological-based screening programs in developed countries led to an increasing number of diagnoses in younger women [2], often in childbearing age. There are enough data on the safety of fertility-sparing treatment of squamous microinvasive cancers (MISC) [3–5] but few on fertility sparing treatment of MIAC [6, 7], in particular, with long-term followup [8, 9]. The occurrence of cervical cancer during pregnancy involves ethical and technical problems, related to the survival of the woman and fetal viability.…”

Section: Introductionmentioning

confidence: 99%

Conservative Treatment of Stage IA1 Adenocarcinoma of the Uterine Cervix during Pregnancy: Case Report and Review of the Literature

Sopracordevole

Rossi

Giuseppe

et al. 2014

Case Reports in Obstetrics and Gynecology

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Microinvasive adenocarcinoma (MIAC) of the uterine cervix is rare in pregnancy. Published data on conservative treatment of MIAC both in pregnant and nonpregnant women are scarce. A conservatively treated case of MIAC in a 13-week-pregnant woman after a diagnosis of atypical glandular cells (AGC) on pap smear at the 6th week of pregnancy is presented. The problems of suspected adenocarcinoma in situ (AIS) on biopsy and MIAC on cone biopsy in pregnancy, as well as the risks and benefits of a conservative treatment are discussed. After colposcopic guide laser cervical conization and expression of informed consent the patient underwent followup and vaginal delivery at 40 weeks plus 3 days of gestation. In this case, no obstetric complication has been recorded after the cervical conization, and after a followup of 18 months the patient was alive and free of disease, with negative results as far as pap smear, colposcopy, HPV status, and cervical curettage are concerned. In a stage Ia1 disease of endocervical type, with clear margins and without lymph-vascular space invasion, cervical conization performed during the second trimester may be considered a definitive and safe treatment, at least up to delivery, after expression of informed consent by the woman.

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“…In another study of 27 patients with FIGO IA1 cervical adenocarcinoma, LVI was not present in any case. 6 It is the experience of one of us (W.G.M.) that LVI is much more uncommon in small cervical adenocarcinomas than in small squamous carcinomas where it is commonly identified.…”

Section: Discussionmentioning

confidence: 99%

“…Two recent studies of smaller numbers of women have also addressed this issue. In the study by Yahata et al, 6 10 of 27 women with FIGO stage IA1 cervical adenocarcinoma were treated by conization alone and followed up for an average of 75 months, with no evidence of recurrence. Reynolds et al 10 concluded that FIGO stage IA1 and stage IA2 cervical adenocarcinomas can be adequately treated with nonradical surgery and without routine pelvic node dissection.…”

Section: Discussionmentioning

confidence: 99%

Do FIGO Stage IA and Small (≤2 cm) IB1 Cervical Adenocarcinomas Have a Good Prognosis and Warrant Less Radical Surgery?

Al-Kalbani

McVeigh

Nagar

et al. 2012

International Journal of Gynecological Cancer

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The optimal management of women with IA or small IB1 cervical adenocarcinoma is controversial, and radical surgery is often undertaken. Our data suggest that there is an extremely low risk of parametrial and lymph node involvement with tumors 2 cm or smaller and a low recurrence rate. Less radical surgery may be warranted for small cervical adenocarcinomas, and this should be addressed by future studies.

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Conservative Treatment of Stage IA1 Adenocarcinoma of the Uterine Cervix With a Long-Term Follow-Up

Cited by 16 publications

References 15 publications

Analysis of treatment modalities and prognosis on microinvasive cervical cancer: a 10-year cohort study in China

Analysis of treatment modalities and prognosis on microinvasive cervical cancer: a 10-year cohort study in China

Conservative Treatment of Stage IA1 Adenocarcinoma of the Uterine Cervix during Pregnancy: Case Report and Review of the Literature

Do FIGO Stage IA and Small (≤2 cm) IB1 Cervical Adenocarcinomas Have a Good Prognosis and Warrant Less Radical Surgery?

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