Vaginal Radical Trachelectomy for Early-Stage Cervical Cancer: Increased Recurrence Risk for Adenocarcinoma

Zusterzeel, Petra L.M.; Pol, Fraukje J.M.; Ham, Maaike van; Zweemer, Ronald P.; Bekkers, Ruud L.M.; Massuger, Leon F.A.G.; Verheijen, René H.M.

doi:10.1097/igc.0000000000000763

Cited by 29 publications

(30 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Although there is a consensus that rare tumor sub-types (eg, clear cell adenocarcinoma or neuroendocrine tumors) have a higher risk of recurrence, it remains still undecided whether this holds true for adenocarcinoma compared with squamous cell carcinoma 23–29. Five of 19 (26%) patients of our cohort had non-squamous histology, involving four patients with adenocarcinoma and one clear cell adenocarcinoma.…”

Section: Discussionmentioning

confidence: 87%

“…Some authors, such as Mabuchi et al, support the view of an inferior prognosis of adenocarcinoma, concluding that adenocarcinoma is an independent unfavorable prognostic factor in surgically treated early stage cervical carcinoma 30. Furthermore, Zusterzeel et al29 reported a significantly higher recurrence rate in adenocarcinoma in a cohort of only vaginal radical trachelectomy. Although this sample size only consists of 19 patients and data comparing both histology sub-types remain limited, our data suggest that, when fertility-sparing surgery is considered, extra caution should be taken in cases of adenocarcinoma.…”

Section: Discussionmentioning

confidence: 98%

See 1 more Smart Citation

Fertility-sparing surgery of cervical cancer >2 cm (International Federation of Gynecology and Obstetrics 2009 stage IB1–IIA) after neoadjuvant chemotherapy

Tesfai

Kroep

Gaarenstroom

et al. 2019

Int J Gynecol Cancer

View full text Add to dashboard Cite

ObjectiveTo assess the feasibility, safety, oncological, and obstetric outcomes in patients with cervical tumors >2 cm treated with neoadjuvant chemotherapy in preparation for abdominal radical trachelectomy.MethodsA retrospective analysis of patients with cervical cancer >2 cm (up to 6 cm) was conducted in patients who were selected to receive neoadjuvant chemotherapy before abdominal radical trachelectomy. Surgical and clinical outcomes were examined in relation to radiological and pathological results. In addition, obstetric outcomes were described. The Mann–Whitney U test and Fisher’s exact test were performed to compare radiological findings between successful and unsuccessful abdominal radical trachelectomy procedures. International Federation of Gynecology and Obstetrics (FIGO) 2009 staging classification was used for this study.ResultsA total of 19 women were treated with neoadjuvant chemotherapy for cervical tumors >2 cm at our institution between May 2006 and July 2018. The median age was 28 years (range 19–36). The distribution of FIGO stages was seven patients stage IB1 (37%), 10 patients stage IB2 (53%), and two patients (10%) stage IIA. Mean clinical tumor size was 4.4 cm (range 3.5–6.0). Histology revealed 74% cases of squamous cell carcinoma. The remaining patients had adenocarcinoma (21%) and only one patient had clear cell adenocarcinoma (5%). Chemotherapy consisted of six weekly cycles of cisplatin (70 mg/m2) and paclitaxel (70 mg/m2). In 15 of the 19 patients (74%) fertility was successfully preserved. In the four patients in whom fertility preservation failed, one patient had stable disease after three cycles and did not meet the criteria for fertility-sparing surgery and three patients had intra- or post-operative indications for adjuvant therapy. Three of the 19 patients (15.7%) had a relapse, two of whom died. One case was in the group of successful abdominal radical trachelectomy.ConclusionNeoadjuvant chemotherapy followed by fertility-sparing surgery may be a feasible and safe option in select patients with cervical tumors >2 cm. Unfavorable prognostic factors are defined as non-responsiveness and non-squamous pathology, which can help in patient selection for fertility-sparing surgery.

show abstract

Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 98%

Fertility-sparing surgery of cervical cancer >2 cm (International Federation of Gynecology and Obstetrics 2009 stage IB1–IIA) after neoadjuvant chemotherapy

Tesfai

Kroep

Gaarenstroom

et al. 2019

Int J Gynecol Cancer

View full text Add to dashboard Cite

show abstract

“…Recent meta-analyses on RVT confirm the reported recurrence and mortality rates of 5 and 2 %, respectively (tumor size ≤ 2 cm) and 11 and 4 %, respectively (tumor size > 2 cm) [73][74][75]. In patients with adenocarcinoma, the risk of recurrence is 13 % and mortality is also higher compared to mortality rates for squamous cell carcinoma [76].…”

Section: Cervical Cancermentioning

confidence: 89%

Preservation of Fertility or Ovarian Function in Patients with Breast Cancer or Gynecologic and Internal Malignancies

Stachs¹,

Hartmann²,

Gerber³

2017

Geburtshilfe Frauenheilkd

View full text Add to dashboard Cite

Because of the efficacy of systemic therapies, neoplasias which occur in pediatric and adolescent patients and in young adults have high cure rates. This means that fulfilling their wish to have children has become a more pressing concern, particularly among young women with malignant tumors. Premature ovarian failure is also a not insignificant problem as it has a lasting detrimental effect on quality of life. Every oncology patient who may potentially wish to have children should be informed about their options for preserving fertility prior to starting treatment. The rates of patient who received detailed briefing on this point remain low. This review presents the effects of different chemotherapeutic drugs on gonadal function together with an overview of currently valid recommendations on fertility preservation. Risk groups are defined and the specific approaches for malignancies of various organ systems are described. Cryopreservation of oocytes, fertilized embryos and ovarian tissue are fertility-preserving options for girls/young women. The data on the benefits of administering GnRH analogs for ovarian protection prior to starting chemotherapy are not clear. In postpubertal boys or male cancer patients, the standard approach is to cryopreserve sperm before starting therapy. The cryopreservation of testicular tissue is possible for prepubertal boys, however in-vitro sperm maturation is still in its experimental stages. This review also presents existing drug options for the preservation of ovarian function in oncology patients prior to chemotherapy, particularly for patients with (hormone-sensitive) breast cancer, and looks at the special issues of fertility-preserving surgery and radiation therapy in patients with gynecologic malignancies.

show abstract

“…4 % (Tumorgröße > 2 cm) [73 -75]. Bei Patientinnen mit einem Adenokarzinom ist das Rezidivrisiko mit 13 % und auch die Mortalität gegenüber Platttenepithelkarzinomen höher [76].…”

Section: Zervixkarzinomunclassified

Erhalt der Fertilität bzw. Ovarialfunktion beim Mammakarzinom sowie bei gynäkologischen und internistischen Malignomen

Stachs¹,

Hartmann²,

Gerber³

2018

TumorDiagn u Ther

View full text Add to dashboard Cite

ZusammenfassungNeoplasien des Kindes- und Jugendalters sowie junger Erwachsener gehen heute dank effektiver Systemtherapien mit einer hohen Heilungschance einher. Demzufolge rückt das Thema „Kinderwunsch“ insbesondere bei jungen Frauen mit Malignom zunehmend in den Vordergrund. Ein nicht unwesentliches Problem ist auch die vorzeitige Ovarialinsuffizienz mit ihren die Lebensqualität nachhaltig beeinträchtigenden Folgen. Jede(r) onkologische Patient(in) mit potenziellem Kinderwunsch sollte vor Therapiebeginn über die Möglichkeiten des Fertilitätserhalts informiert werden. Die Aufklärungsrate ist diesbezüglich nach wie vor gering. In dieser Übersichtsarbeit wird der Effekt verschiedener Chemotherapeutika auf die Gonadenfunktion dargestellt sowie ein Überblick über die aktuell gültigen Empfehlungen zum Fertilitätserhalt gegeben.Dabei werden Risikokollektive definiert und das spezifische Vorgehen bei Malignomen der verschiedenen Organsysteme beschrieben. Bei Mädchen/jungen Frauen ist die Kryokonservierung von Eizellen, befruchteten Embryonen und Ovargewebe möglich. Zum Nutzen der GnRH-Analoga-Applikation zum Ovarschutz vor Chemotherapie ist die Studienlage uneinheitlich. Bei postpubertären Jungen bzw. männlichen Krebspatienten ist die Kryokonservierung von Spermien vor Therapiebeginn Standard. Bei Jungen im vorpubertären Alter ist die Kryokonservierung von Hodengewebe möglich, jedoch ist die In-vitro-Spermienreifung noch im experimentellen Stadium. Des Weiteren werden in der vorliegenden Arbeit medikamentöse Möglichkeiten des Erhalts der Ovarfunktion bei onkologischen Patienten vor Chemotherapien, insbesondere bei (hormonabhängigem) Mammakarzinom, sowie die speziellen Fragestellungen der Planung von fertilitätserhaltender Operation und Radiatio bei gynäkologischen Malignomen, dargestellt.

show abstract

Vaginal Radical Trachelectomy for Early-Stage Cervical Cancer: Increased Recurrence Risk for Adenocarcinoma

Cited by 29 publications

References 38 publications

Fertility-sparing surgery of cervical cancer >2 cm (International Federation of Gynecology and Obstetrics 2009 stage IB1–IIA) after neoadjuvant chemotherapy

Fertility-sparing surgery of cervical cancer >2 cm (International Federation of Gynecology and Obstetrics 2009 stage IB1–IIA) after neoadjuvant chemotherapy

Preservation of Fertility or Ovarian Function in Patients with Breast Cancer or Gynecologic and Internal Malignancies

Erhalt der Fertilität bzw. Ovarialfunktion beim Mammakarzinom sowie bei gynäkologischen und internistischen Malignomen

Contact Info

Product

Resources

About