Laparoscopic lymph node dissection should be performed before fertility preserving treatment of patients with cervical cancer

• Published in: Gynecologic oncology Vol. 126; no. 3; pp. 325 - 329
• Main Authors: Vercellino, Giuseppe F, Piek, Jurgen M.J, Schneider, Achim, Köhler, Christhardt, Mangler, Mandy, Speiser, Dorothee, Chiantera, Vito
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2012
• Subjects: Adenocarcinoma - pathology; Adenocarcinoma - therapy; Adult; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Brachytherapy; Carcinoma, Squamous Cell - pathology; Carcinoma, Squamous Cell - therapy; Cervical carcinoma; Cervix Uteri - surgery; Chemoradiotherapy; Chemotherapy, Adjuvant; Cisplatin - administration & dosage; Female; Fertility Preservation; Follow-Up Studies; Hematology, Oncology and Palliative Medicine; Humans; Ifosfamide - administration & dosage; Laparoscopy; Lymph Node Excision; Lymphatic Metastasis; Neoadjuvant chemotherapy; Neoadjuvant Therapy; Neoplasm Recurrence, Local; Neoplasm Staging; Obstetrics and Gynecology; Paclitaxel - administration & dosage; Pelvis; Prospective Studies; Radical vaginal trachelectomy; RVT; Uterine Cervical Neoplasms - pathology; Uterine Cervical Neoplasms - therapy; Neoadjuvant chemotherapy; RVT; Cervical carcinoma; Radical vaginal trachelectomy
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2012.05.033

Abstract Objective The aim of this study is to assess our results of treatment of women with stage I cervical cancer > 2 cm in diameter seeking fertility preservation. Treatment consisted of Laparoscopic Pelvic and Paraaortic Lymphadenectomy (LPPLND), and when no nodal metastasis was detected, neoadjuvant chemotherapy (NACT) followed by radical vaginal trachelectomy (RVT). Patients with positive lymph nodes underwent primary chemoradiation. Methods A cohort of women younger than 40 years of age with stage I disease > 2 cm who underwent LPPLND and either NACT and RVT or chemoradiation. Oncological outcome was evaluated prospectively. Results Eighteen women were eligible for this study. Twelve (67%) women were diagnosed with metastasis in one or more pelvic and/or paraaortic lymph nodes, and thus received primary chemoradiation. After a mean follow-up of 25.5 months, three out of these 12 women (25%) developed a recurrence. Six women (33%) underwent NACT and RVT. Three patients experienced complete response to NACT and three patients showed more than 50% tumor size reduction. After a mean follow-up of 30.6 months all six women are free of recurrence. One patient delivered a healthy infant. Conclusions Staging LPPLND allows separating patients in high or low recurrence risk groups. NACT and RVT seem to be safe for women with completely staged stage I cervical cancer > 2 cm in diameter, whereas even after primary chemoradiation, patients with positive lymph nodes experienced recurrence. Therefore, selection of patients with stage I cervical carcinoma > 2 cm, eligible for fertility preservation should include histopathologic evaluation of lymph node status before any further treatment.