Oncological and pregnancy outcomes after high-dose density neoadjuvant chemotherapy and fertility-sparing surgery in cervical cancer
Jazyk angličtina Země Spojené státy americké Médium print-electronic
Typ dokumentu časopisecké články, práce podpořená grantem
PubMed
25159484
DOI
10.1016/j.ygyno.2014.08.021
PII: S0090-8258(14)01274-8
Knihovny.cz E-zdroje
- Klíčová slova
- Cervical cancer, Fertility outcome, Fertility-sparing surgery, Neoadjuvant chemotherapy, Pregnancy outcome, Trachelectomy,
- MeSH
- adenokarcinom farmakoterapie patologie MeSH
- cervix uteri patologie chirurgie MeSH
- cisplatina aplikace a dávkování MeSH
- dospělí MeSH
- doxorubicin aplikace a dávkování MeSH
- hysterektomie MeSH
- ifosfamid aplikace a dávkování MeSH
- léčba šetřící orgány metody MeSH
- lidé MeSH
- lymfadenektomie MeSH
- mladiství MeSH
- mladý dospělý MeSH
- nádory děložního čípku farmakoterapie patologie MeSH
- neoadjuvantní terapie metody MeSH
- porod v termínu MeSH
- předčasný porod epidemiologie MeSH
- prospektivní studie MeSH
- protokoly antitumorózní kombinované chemoterapie terapeutické užití MeSH
- reziduální nádor MeSH
- samovolný potrat epidemiologie MeSH
- spinocelulární karcinom farmakoterapie patologie MeSH
- staging nádorů MeSH
- těhotenství MeSH
- výsledek těhotenství epidemiologie MeSH
- zachování plodnosti metody MeSH
- ženská infertilita epidemiologie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mladiství MeSH
- mladý dospělý MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Názvy látek
- cisplatina MeSH
- doxorubicin MeSH
- ifosfamid MeSH
OBJECTIVE: 28 women under 35years with early-stage cervical cancer and strong desire for fertility preservation that do not fulfil standard criteria for fertility-sparing surgery (tumour larger than 2cm or with deep of infiltration more than half of stroma) were included in prospective study. METHODS: Dose-dense neoadjuvant chemotherapy (NAC) was performed on all 28 patients in 10-day intervals: cisplatin plus ifosfamide in squamous cell cancer (15 women-53.6%) or cisplatin plus doxorubicin in adenocarcinoma (13 women-46.3%). Patients underwent laparoscopic lymphadenectomy and vaginal simple trachelectomy after NAC. Patients with positive lymph nodes or inadequate free surgical margins underwent radical hysterectomy. RESULTS: No residual disease was found in 6 women (21.4%), microscopic disease was observed in 11 women (39.3%) and macroscopic tumour in was observed in 11 women (39.3%). Ten women (35.7%) lost fertility. Four women (20%) after fertility-sparing surgery recurred, two died of the disease (10%). Fertility was spared in 20 (71.4%) women and 10 of them became pregnant (50%). Eight women delivered ten babies (6 term and four preterm deliveries). There were two miscarriages in second trimester (in one woman) and one in first trimester. One woman underwent four unsuccessful cycles of IVF, one failed to become pregnant and one recurred too early. Two women underwent chemoradiotherapy for recurrence and lost chance for pregnancy. CONCLUSIONS: Downstaging by NAC in IB1 and IB2 cervical cancer before fertility-sparing surgery is still an experimental procedure, but shows some promise. Long-term results in relation to oncological outcome for this concept are still needed.
Department of Obstetrics and Gynecology 2nd Medical Faculty Charles University Prague Czech Republic
Department of Radiology 2nd Medical Faculty Charles University Prague Czech Republic
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