Neoadjuvant chemotherapy and conservative surgery for stage IB1 cervical cancer

Objectives. To assess the effectiveness of chemo-surgical conservative therapy for stage IBI cervical tumors in patients desiring to preserve fertility. Methods. From 1995 to April 2007 51 nulliparous patients with turner <= 3 cm, aged <= 40 years with no uterine and lymphnode neoplastic involvement were evaluated. Three courses with cisplatin 75 mg/m(2), paclitaxel 175 mg/m(2) and ifosfamide 5 g/m(2) (epirubicin 80 mg/m(2) in adenocarcinoma) were followed by cold-knife conization and pelvic lymphadenectomy. When intraoperative frozen section revealed massive neoplastic cervical persistence a radical total hysterectomy was performed. Results. Thirty women (59%) did not accept the conservative approach. fit the remaining 21 patients median age was 30 years and median tumor size was 15 mm (range 10-30 mm). Adenocarcinoma was present in 12 cases (57%) and indifferentiated neoplasia in 10 (48%). Following neoadjuvant treatment. pathological complete response was observed in 5 cases, in situ or microinvasive residue in 12 and stromal invasion >3 mm in 4. Four women deemed ineligible for conservative surgery after chemotherapy and one refusing to preserve her genital apparatus Underwent radical hysterectomy. After a median follow-Lip of 69 months no relapses were observed. Nine women attempted to conceive: ten pregnancies occurred in 6 patients and 9 live babies have been borne while one woman experienced a first-trimester miscarriage. Conclusions. The high rate of pathological response confirms the effectiveness of the preoperative treatment for reducing the tumor volume allowing the removal only of a cervical cone instead of the entire cervix with cardinal ligaments as needed by radical trachelectomy. Successful pregnancies are possible after such integration. (C) 2008 Elsevier Inc. All rights reserved.