Fertility sparing treatment in women affected by cervical cancer larger than 2 cm

Objective > We report our experience on fertility sparing treatment in young women affected by cervical cancer of more than 2 cm. Methods > Between July 2012 and February 2014, five patients presenting cervical tumors larger than 2 cm (IB1 > 2 cm) (23-35) and wishing to preserve fertility have been treated at our institution. Laparoscopic pelvic and para-aortic lymphadenectomy was performed for all patients. When lymph nodes were free of disease, patients had neoadjuvant chemotherapy followed by surgical conservative treatment. Results > Four patients underwent a cisplatin based neoadjuvant chemotherapy before conservative surgery: radical trachelectomy or simple trachelectomy. One patient with nodal involvement underwent a 3 cycle chemotherapy followed by concurrent radiochemotherapy. Hematologic toxicity grade 3 was observed in one patient leading to a change of chemotherapy. Two patients showed complete disappearance of tumor and two a partial response to neoadjuvant treatment. After a mean follow up of 20.5 months (14-33), no relapse was observed. To date, no pregnancy was obtained. Conclusion > Lymph node staging followed by neoadjuvant chemotherapy and radical trachelectomy seems to be a promising treatment scheme for patients with cervical tumors IB1 > 2 cm pN0 seeking parenthood.