Neoadjuvant intra-arterial chemotherapy followed by total laparoscopic radical trachelectomy in stage IB1 cervical cancer

Objective: To support the feasibility and safety of neoadjuvant intra-arterial chemotherapy followed by total laparoscopic radical trachelectomy in stage IB1 cervical cancer with tumor larger than 2 cm. Design: A retrospective study. Setting: University-affiliated gynecologic oncology department. Patient(s): Patients with stage IB1 cervical cancer with tumor size larger than 2 cm who wish to preserve fertility. Intervention(s): Neoadjuvant intra-arterial chemotherapy followed by laparoscopic radical trachelectomy. Main Outcomes Measure(s): Data regarding neoadjuvant chemotherapy operational time, blood loss, recurrence, and subsequent pregnancies were recorded. Other published reports on neoadjuvant chemotherapy followed by radical trachelectomy were reviewed. Result(s): Seven patients had a laparoscopic radical trachelectomy after neoadjuvant intra-arterial chemotherapy for stage IB1 cervical cancer. Median tumor diameter evaluated by colposcopy was 3.3 cm (range, 2.5-4.0 cm), tumor histotype was all squamous. All patients showed complete or partial response to neoadjuvant chemotherapy, and they were all treated with total laparoscopic radical trachelectomy. One patient had no menses after treatment. After a median 66 months (range, 12-90 months) of follow-up time, no recurrence was observed. Only four patients attempted to conceive and two succeeded. Conclusion(s): Neoadjuvant intra-arterial chemotherapy followed by total laparoscopic radical trachelectomy may become a useful option for women with cervical cancer with a tumor size larger than 2 cm who wish to preserve fertility. Ovarian protection warrants further investigation. (C) 2014 by American Society for Reproductive Medicine.