Simple Trachelectomy Following Neoadjuvant Chemotherapy in Cervical Cancer Over 2 cm in Size - a Case Report and Review of Literature

  • Aljoša Mandić Oncology Institute of Vojvodina
  • Bojana Gutić University of Novi Sad, Medical faculty, Oncology institute of Vojvodina
  • Miona Davidović-Grigoraki Private gynecological office Miona Davodovic-Grigoraki, Athens, Greece
  • Đorđe Petrović University of Novi Sad, Medical faculty, Clinical center of Vojvodina
  • Nenad Šolajić University of Novi Sad, Medical faculty, Oncology institute of Vojvodina
  • Gabrijel-Stefan Nađ Oncology institute of Vojvodina
Keywords: “Bulky” cervical cancer, Fertility sparing surgery, Neoadjuvant chemotherapy

Abstract


In the past few decades fertility preservation has emerged as a treatment modality for cervical cancer patients. Different surgical methods have been described, such as open or minimally invasive trachelectomy and gross cervical conisation combined with laparoscopic lymphadenectomy. A thirty-year-old nulliparous woman with uterine cervical cancer FIGO stage IB2 (classification from 2009) underwent neoadjuvant chemotherapy. After three cycles of chemotherapy with cisplatin and iphosphamide there was no colposcopic findings of cervical invasion, therefore a conservative surgery was performed. The patient underwent laparoscopic pelvic lymphadenectomy, cervical amputation and the endocervical curettage. The histopathology confirmed a complete response to chemotherapy.

Author Biography

Aljoša Mandić, Oncology Institute of Vojvodina

References

Covens A, Rosen B, Murphy J, Laframboise S, DePetrillo AD, Lickrish G, et al. Changes in the demographics and perioperative care of stage IA(2)/ IB(1) cervical cancer over the past 16 years. Gynecol Oncol 2001;81(2):133–7.

Schneider A, Erdemoglu E, Chiantera V, Reed N, Morice P, Rodolakis A, et al. Clinical recommendation radical trachelectomy for fertility preservation in patients with early- stage cervical cancer. Int J Gynecol Cancer 2012;22:659 – 66.

Rob L, Pluta M, Strnad P, Hrehorcak M, Chmel R, Skapa P, et al. A less radical treatment option to the fertility-sparing radical trachelectomy in patients with stage I cervical cancer. Gynecol Oncol 2008;111:116 –20.

Mandic A, Novakovic P, Nincic D. Surgical approaches towards fertility preservation in young patients with early invasive cervical carcinoma. J BUON; 2009;14:581-6.

Novak F. Radical abdominal subcorporeal extirpation of the cervix with bilateral pelvic lymph nodes dissection in cancer in situ of the cervix uteri. Acta Med Iugosl 1952;6:59-71.

Dargent D, Brun J, Roy M, Mathevet P. [An operation enabling to manage young patients affected by invasive cervical cancer while preserving the fertility potential: the radical trachelectomy]. J Obstet Gynecol 1994;2:285–92. French.

Wethington SL, Cibula D, Duska LR, Garrett L, Kim CH, Chi DS, et al. An international series on abdominal radical trachelectomy: 101 patients and 28 pregnancies. Int J Gynecol Cancer 2012 Sep;22(7):1251-7.

Robova H, Rob L, Halaska MJ, Pluta M, Skapa P, Strnad P, et al. High-dose density neoadjuvant chemotherapy in bulky IB cervical cancer. Gynecol Onc 2013;128:49–53.

Plante M. Evolution in fertility-preserving options for early- stage cervical cancer. Radical trachelectomy, simple trachelectomy, neoadjuvant chemotherapy. Int J Gynecol Cancer 2013;23:982-9.

Shirali E, Yarandi F, Behtash N, Hemmatian O. Neoadjuvant chemotherapy in cervical cancer: a review article. J Obstet Gynecol Cancer Res 2018;3(2):87-91.

Marchiole P, Tigaud JD, Costantini S, Mammoliti S, Buenerd A, Moran E, et al. Neoadjuvant chemotherapy and vaginal radical trachelectomy for fertility-sparing treatment in women affected by cervical cancer (FIGO stage IB-IIA1). Gynecol Oncol 2011 Sep;122(3):484-90.

Robova H, Halaska M, Pluta M, Skapa P, Strnad P, Lisy J, et al. The role of neoadjuvant chemotherapy and surgery in cervical cancer. Int J Gynecol Cancer 2010;20(11 Supp l 2):S42 – 6.

Maneo A, Chiari S, Bonazzi C, Mangioni C. Neoadjuvant chemotherapy and conservative surgery for stage I B1 cervical cancer . Gynecol Oncol 2008;111(3):438–43.

Plante M, Lau S, Brydon L, Swenerton K, LeBlanc R, Roy M. Neoadjuvant chemotherapy followed by vaginal radical trachelectomy in bulky stage IB1 cervical cancer: case report. Gynecol Oncol 2006;101:367–70.

Palaia I, Musella A, Loprete E, Achilli C, Perniola G, Panici PB. Neoadjuvant chemotherapy plus fertility-sparing surgery in locally advanced cervical cancer: case report. J Minim Invasive Gynecol 2011;18(1):121–2.

Kobayashi Y, Akiyama F, Hasumi K. A case of successful pregnancy after treatment of invasive cervical cancer with systematic chemotherapy and conisation. Gynecol Oncol 2006;100:213-5.

Lanowska M, Mangler M, Speiser D, Bockholdt C, Schneider A, Kohler C, et al. Radical vaginal trachelectomy after laparoscopic staging and neoadjuvant chemotherapy in women with early-stage cervical cancer over 2 cm. Int J Gynecol Cancer 2014;24:586-93.

Buda A, Borghese M, Puppo A, Perotto S, Novelli A, Borghi C, et al. Neoadjuvant Chemotherapy Prior Fertility-Sparing Surgery in Women with FIGO 2018 Stage IB2 Cervical Cancer: A Systematic Review. Cancers (Basel) 2022 Feb 4;14(3):797. doi: 10.3390/cancers14030797.

Young RH, Clement PB. Endocervical adenocarcinoma and its variants: their morphology and differential diagnosis. Histopathology 2002;41:185-207.

Chan PG, Sung HY, Sawaya GF. Changes in cervical cancer incidence after three decades of screening US women less than 30 years old. Obstet Gynecol 2003;102:76:5–73.

Galic V, Herzog TJ, Lewin SN, Neugut AI, Burke WM, Yu-Shiang L, at al. Prognostic significance of adenocarcinoma histology in women with cervical cancer. Gynecologic Oncology 2012;125:287–91.

Gien LT, Beauchemin MC, Thomas G. Adenocarcinoma: a unique cervical cancer. Gynecol Oncol 2010;116:140–6.

Zhou J, Chen Y, Xu X, Yan D, Lou H. Postoperative clinicopathological factors affecting cervical adenocarcinoma: Stages I-IIB. Medicine (Baltimore) 2018 Jan;97(2):e9323. doi: 10.1097/MD.0000000000009323.

Gil-Ibañez B, Gil-Moreno A, Torné A, Martín Jimenez A, Gorostidi M, Zapardiel I, et al, on behalf of Sego Spain-Gog Cervical Cancer Task Forcé. Tumor size and oncological outcomes in patients with early cervical cancer treated by fertility preservation surgery: a multicenter retrospective cohort study. Cancers (Basel) 2022 Apr 23;14(9):2108. doi: 10.3390/cancers14092108.

Plante M, van Trommel N, Lheureux S, Oza AM, Wang L, Sikorska K, et al. FIGO 2018 stage IB2 (2-4 cm) Cervical cancer treated with Neo-adjuvant chemotherapy followed by fertility Sparing Surgery (CONTESSA); Neo-Adjuvant Chemotherapy and Conservative Surgery in Cervical Cancer to Preserve Fertility (NEOCON-F). A PMHC, DGOG, GCIG/CCRN and multicenter study. Int J Gynecol Cancer 2019 Jun;29(5):969-75.

Published
2022/09/30
Section
Case report