Neoadjuvant Chemotherapy Followed by Fertility Sparing Surgery in Cervical Cancers Size 2-4 cm: Emerging Data and Future Perspectives

Collaborative Clinical Outcomes Research Article Published in Gynecologic Oncology

Nnamdi Gwacham, MD
Robert W. Holloway, MD
Nathalie D. McKenzie, MD
Sarfraz Ahmad, MD
Gynecologic Oncology Program
AdventHealth Cancer Institute


Nnamdi I. Gwacham1, Nathalie D. McKenzie1,2, Evan Fitzgerald2, Sarfraz Ahmad1,2, Robert W. Holloway1,2
1AdventHealth Cancer Institute, Gynecologic Oncology Program, and 2Florida State University, College of Medicine, Orlando, FL. 32804

Summary

Background: Approach to the management of early-stage cervical cancers with tumor size >2 cm in women who desire fertility preservation has been fraught with controversy. Fertility sparing surgery for FIGO 2018 stage IB cancers has been validated most for tumors ≤ 2 cm. In this review, our objective was to evaluate the oncologic and obstetric outcomes for women that underwent neoadjuvant chemotherapy (NACT) before fertility sparing surgery for tumors 2-4 cm.

Methods: We performed a systematic literature review and searched PubMed, Google Scholar, Cochrane Reviews and UpToDate (from January 2000 to February 2021) using the terms: cervical cancer, fertility preservation, trachelectomy, radical trachelectomy, neoadjuvant chemotherapy, cervical cancer treatment, stage IB1 or IB2 cervical cancer, and cervical cancer size 2-4 cm. We included manuscripts with information on patients with tumor sizes 2-4 cm, lymph node status, follow-up, obstetric and oncologic outcome. We excluded review articles or articles without all pertinent patient information.

Results: Eighteen articles were identified including 249 patients. For final analysis, 114 cases met inclusion criteria. All included patients had FIGO 2018 stage IB2 cervical cancer, underwent neoadjuvant chemotherapy and subsequent fertility sparing surgery. Vaginal radical trachelectomy, cold knife conization, abdominal radical trachelectomy, laparoscopic radical trachelectomy, simple vaginal trachelectomy, and cone laser were performed in 46 (40.4%), 26 (22.8%), 14 (12.3%), 13 (11.4%), 8 (7%), and 7 (6.1%) women, respectively. The most common regimen of chemotherapy was platinum-based therapy with cisplatin. The follow-up time reported in all studies ranged from 1 to 225 months. Of 64 attempted pregnancies, there were 49 (76.6%) viable deliveries which included six preterm births (9.4%). The recurrence rate was 6.1%, and two patients (1.8%) died of disease.

Conclusion: Fertility sparing surgery following NACT is an option for women with cervical cancers that are 2-4 cm who wish to preserve fertility without sacrificing oncologic or obstetric outcomes. Confirmation of these findings are anticipated from an ongoing international Phase II clinical trial.

Highlights

  • Response rate to neoadjuvant chemotherapy is 92% for cervical cancer 2-4 cm.
  • Recurrence rate is 6.1% after neoadjuvant chemotherapy and fertility sparing surgery.
  • Obstetric outcomes appear to be favorable in this subset of patients.

For more information or to refer a patient, call GYN Oncology Nurse Navigator Althea Buckner, MSN, APRN-AOCNP, at Call407-303-5909.

Read the article.

Recent News

12 items. To interact with these items, press Control-Option-Shift-Right Arrow. These items are in a slider. To advance slider forward, press Shift-Command-Right Arrow. To advance slider backward, press Shift-Command-Left Arrow.
News
AdventHealth Neuroscience Institute Administers First Dose of Investigative NK Cell Therapy to Person with Alzheimer’s Disease

Under a single compassionate use Investigational New Drug (IND) authorization cleared by the U.S. Food and Drug Administration (FDA), the AdventHealth Neuroscience Institute worked with NKGen Biotech...

Read Article about "AdventHealth Neuroscience Institute Administers First Dose of Investigative NK Cell Therapy to Person with Alzheimer’s Disease "
News
New Study Published in the New England Journal of Medicine Shows the Addition of Regional Nodal Irradiation Does Not Decrease Rate of Invasive Breast Cancer Recurrence in Patients with Negative Axillary Nodes Following Neoadjuvant Chemotherapy

Findings of the phase III, multicenter, randomized NSABP B-51-RTOG 1304 clinical trial were recently published in the New England Journal of Medicine with AdventHealth Cancer Institute’s Dr. Mamounas...

Read Article about "New Study Published in the New England Journal of Medicine Shows the Addition of Regional Nodal Irradiation Does Not Decrease Rate of Invasive Breast Cancer Recurrence in Patients with Negative Axillary Nodes Following Neoadjuvant Chemotherapy "
News
AdventHealth Study Exploring the Use of MR-Guided Focused Ultrasound (MRgFUS) to Disrupt the Blood-Brain Barrier for Treatment of Alzheimer’s Disease

Under the leadership of Dr. Valeria Baldivieso and Dr. Chandan Reddy, the AdventHealth Research Institute is the first and only site in Orlando offering the Exablate Blood-Brain Barrier (BBB)...

Read Article about "AdventHealth Study Exploring the Use of MR-Guided Focused Ultrasound (MRgFUS) to Disrupt the Blood-Brain Barrier for Treatment of Alzheimer’s Disease"
News
AdventHealth’s Karen D. Corbin, PhD, RD, Contributed to New American Diabetes Association Consensus Statement on Liver Disease in Diabetes

Metabolic dysfunction associated steatotic liver disease (MASLD), formerly referred to as nonalcoholic fatty liver disease (NAFLD), affects about 70% of people with type 2 diabetes, placing them at...

Read Article about "AdventHealth’s Karen D. Corbin, PhD, RD, Contributed to New American Diabetes Association Consensus Statement on Liver Disease in Diabetes "
News
AdventHealth Research Institute and NESTRE Health & Performance Announce Collaboration to Advance Neurocognitive Health and Performance Through Cognitive Training

With an aging population and increases in the prevalence of neurological conditions like Alzheimer’s disease and dementia, physicians and patients alike continue to seek new tools and approaches to...

Read Article about "AdventHealth Research Institute and NESTRE Health and Performance Announce Collaboration to Advance Neurocognitive Health and Performance Through Cognitive Training "
View More Articles