Oncological outcomes after fertility-sparing surgery for cervical cancer: a systematic review

Bentivegna, Enrica; Gouy, Sébastien; Maulard, Amandine; Chargari, Cyrus; Leary, Alexandra; Morice, Philippe

doi:10.1016/s1470-2045(16)30032-8

Cited by 229 publications

(228 citation statements)

References 86 publications

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“…In this light, fertility sparing treatment should be offered in young patients with early stage disease and strong desire for fertility preservation [3,4,6,7]. This is the reason why, recent and the supporting ligaments are being excised [3,30].…”

Section: Editorialmentioning

confidence: 99%

“…guidelines incorporate conservative surgical treatment options in well selected patients after extensive counseling regarding risks for recurrence, anticipated future fertility, pregnancy issues and perinatal outcomes [3,[6][7][8]. Nevertheless, patients with aggressive (small cell neuroendocrine carcinoma) or potentially aggressive (gastric type adenocarcinoma, minimal deviation adenocarcinoma) histologic subtypes, are not eligible for fertility sparing management [3,9,10].…”

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confidence: 99%

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Fertility Sparing Approach in Young Patients with Early Stage Cervical Cancer

Georgios¹

2017

OGIJ

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Section: Editorialmentioning

confidence: 99%

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confidence: 99%

Fertility Sparing Approach in Young Patients with Early Stage Cervical Cancer

Georgios¹

2017

OGIJ

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“…Options include neoadjuvant chemotherapy after pelvic lymph node staging, followed by conservative surgery (trachelectomy). While first results are encouraging, this treatment must still be considered experimental [23]. …”

Section: Figo Ib1 and Iia1mentioning

confidence: 99%

Surgical Treatment of Early-Stage Cervical Cancer

Brucker

Ulrich

2016

Oncol Res Treat

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Surgical treatment of cervical cancer has been a cornerstone in the management of this malignancy for more than 100 years. Today, for early-stage and low-risk cervical cancer, surgery is still considered the gold standard. If the preoperative assessment of the tumor reveals a situation prompting postoperative adjuvant radiochemotherapy, the latter should be planned as the primary treatment option, being preceded by staging laparoscopy including pelvic and paraaortic lymph node dissection. As an alternative to the open approach, the definitive surgical treatment should be either performed laparoscopically, or be laparoscopic-assisted, or laparoscopically robotic-assisted.

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“…However, patients with sub-optimal chemotherapy response were at higher risk of recurrence and death, suggesting that the lack of response to neo-adjuvant chemotherapy is a marker of worse outcome 16 18. Bentivegna et al reviewed data from 17 series and case reports of neo-adjuvant chemotherapy followed by less radical surgery, confirming good oncologic outcome in good chemo-responders 6. In addition, obstetrical outcome is favorable following that approach and appears superior compared with patients undergoing upfront radical trachelectomy 6 17.…”

Section: Introductionmentioning

confidence: 98%

“…Adjuvant radiotherapy not only precludes the chances of childbearing but it also ruins ovarian function, leading to definitive premature menopause and a permanent impact on quality of life and sexual health. For patients who preserve their fertility potential following abdominal radical trachelectomy, the fertility rate and obstetrical outcome appear to be reduced 6. A recent series of 151 abdominal radical trachelectomies confirmed that infertility treatments were frequently required following the procedure and that premature rupture of membranes and premature labor were frequently observed 12.…”

Section: Introductionmentioning

confidence: 99%

FIGO 2018 stage IB2 (2–4 cm) Cervical cancer treated with Neo-adjuvant chemotherapy followed by fertility Sparing Surgery (CONTESSA); Neo-Adjuvant Chemotherapy and Conservative Surgery in Cervical Cancer to Preserve Fertility (NEOCON-F). A PMHC, DGOG, GCIG/CCRN and multicenter study

Plante

Trommel

Lheureux

et al. 2019

Int J Gynecol Cancer

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BackgroundThere are limited data regarding the optimal management of pre-menopausal women with cervical lesions measuring 2–4 cm who desire to preserve fertility.Primary objectivesTo evaluate the feasibility of preserving fertility.Study hypothesisNeo-adjuvant chemotherapy will be effective in reducing the size of the tumor and will enable fertility-sparing surgery without compromising oncologic outcome.Trial designPre-menopausal women diagnosed with stage International Federation of Gynecology and Obstetrics (FIGO) IB2, 2–4 cm cervical cancer who wish to preserve fertility will receive three cycles of platinum/paclitaxel chemotherapy. Patients with complete/partial response will undergo fertility-sparing surgery. Patients will be followed for 3 years to monitor outcome. Patients with suboptimal response (residual lesion ≥2 cm) will receive definitive radical hysterectomy and/or chemoradiation.Major eligibility criteriaPatients must have histologically confirmed invasive cervical cancer, 2–4 cm lesion, by clinical examination and magnetic resonance imaging (MRI), negative node, and pre-menopausal (≤40 years old). Following three cycles of neo-adjuvant chemotherapy, patients must achieve a complete/partial response (residual lesion <2 cm). Exclusion criteria include high-risk histology, tumor extension to uterine corpus/isthmus (as per MRI), and suboptimal response/progression following neo-adjuvant chemotherapy.Primary endpointsAssess the rate of functional uterus defined as successful fertility-sparing surgery and no adjuvant therapy.Sample sizeA total of 90 evaluable patients will be needed to complete the study.Estimated dates for completing accrual and presenting resultsExpected complete accrual in 2022 with presentation of results by 2025.Trial registration numberPending ethics submission.

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Oncological outcomes after fertility-sparing surgery for cervical cancer: a systematic review

Cited by 229 publications

References 86 publications

Fertility Sparing Approach in Young Patients with Early Stage Cervical Cancer

Fertility Sparing Approach in Young Patients with Early Stage Cervical Cancer

Surgical Treatment of Early-Stage Cervical Cancer

FIGO 2018 stage IB2 (2–4 cm) Cervical cancer treated with Neo-adjuvant chemotherapy followed by fertility Sparing Surgery (CONTESSA); Neo-Adjuvant Chemotherapy and Conservative Surgery in Cervical Cancer to Preserve Fertility (NEOCON-F). A PMHC, DGOG, GCIG/CCRN and multicenter study

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