Dose-dense neoadjuvant chemotherapy followed by sentinel node mapping and laparoscopic pelvic lymphadenectomy and simple trachelectomy in cervical cancer: update results

Neoadjuvant chemotherapy in fertility-sparing management of FIGO 2018 stage IB2 cervical cancer

“…If we look at the recurrences reported and type of surgery, recurrences reported by Lanowska et al ( n=1), Machiole et al (n=2), and Zusterzeel et al (n=3 ) had been observed after vaginal radical trachelectomy 6 8 13 . Recurrences observed in the Robova et al (n=5), Rendon et al (n=1), and de Vicenzo et al (n=1 ) series had been reported after simple cone/trachelectomy by vaginal approach 9 11 12 . Three recurrences were observed after radical trachelectomy by abdominal approach ( one after laparotomy in the series of Tesfai et al and two after a laparoscopic pure approach in the series of Rendon et al ) 10 11 .…”

“…In patients receiving neoadjuvant chemotherapy, the highest rate of affected margins is reported by Robova and Rob with 6 of 20 patients having positive margins after simple trachelectomy 9 . Rendon et al noted one case of positive margins on a conization specimen; others have reported no cases of positive margins in patients with stage IB2 disease after neoadjuvant chemotherapy 11 .…”

“…Results in the literature describe 22 conizations (20.2%), 20 simple trachelectomies (18.3%), and 67 radical trachelectomies (61.5%) (34 vaginal, 17 abdominal, and 16 laparoscopic) 4–15 . It is difficult to evaluate margin status and correlate this with the type of surgery as this information is often not available in the literature.…”

“…Results of neoadjuvant chemotherapy in the setting of fertility preservation in early cervical cancer are reported in a number of small series with heterogeneous management strategies and the majority are retrospective in nature. 4–14 These studies often reflect high rates of complete response (>50%), allowing for a safer fertility-sparing surgery. The first item raised in this second case is the rate of stable or progressive disease after neoadjuvant chemotherapy thus requiring additional treatment (chemoradiation therapy or adjuvant hysterectomy), thus making fertility preservation implausible.…”

“…However, new cases of recurrent disease have been reported in different series during the past 5 years, thus increasing the reported recurrence rates. 4–15 Considering these latest series, the recurrence rates after neoadjuvant chemotherapy, whatever the disease stage, is around 8% (stage IB1 disease) and up to 13% in the selected subgroup (stage IB2 disease). 16 17 Some of these recurrences are observed even in patients with a favorable response (regression >50% of the initial tumor size), free margins, and no LVSI on specimen .…”