By Michael Casasnovas
TAMPA, Fla -- March 14, 2008 -- Vaginal radical trachelectomy provides a safe fertility-preserving option for young women with early-stage cervical cancer, researchers reported here at the Society of Gynecologic Oncologists (SGO) 2008 Annual Meeting on Women's Cancer.
"Oncological results are reassuring, obstetrical results are promising, and fertility results do not appear to be compromised," said Marie Plante, MD, Associate Professor of Gynecologic Oncology, Laval University, Quebec City, Quebec, Canada.
Researchers conducted a retrospective review of 113 consecutive completed vaginal radical trachelectomy procedures in women aged <45 years who wished to preserve fertility. Patients' histologies consisted of squamous or adenocarcinoma with lesion sizes 2.0 cm or less in diameter and limited endocervical involvement as determined by magnetic resonance imaging and/or colostomy.
Laparoscopic sentinel node mapping and bilateral pelvic node dissection preceded the vaginal radical trachelectomy. Researchers abandoned vaginal radical trachelectomy if the sentinel node was positive or upon finding extensive endocervical involvement.
Patients were followed for a mean of 74 months. Cervical cancer recurred in 4 women (3.5%) and 2 women (1.8%) died; 95% of patients achieved at least a 5-year disease-free survival.
Twelve of the women experienced fertility problems, Dr. Plante said in her poster presentation on March 10. Despite complications, 9 (75%) of those women achieved conception. The causes of infertility included difficulty in ovulation in 5 cases, endometriosis in 2 women, cervical stenosis in 2 women, and unknown causes in 3 other patients.
"Evaluation by a fertility specialist is important and patients should have realistic expectations," said Dr. Plante.
Fifty-one women who underwent the surgery achieved 87 pregnancies. These women had a median age of 32 years, ranging from 21 to 42 years. She said that 31 of the women who conceived had 1 pregnancy (61%); 9 women had 2 pregnancies; 6 women had 3 pregnancies; and 5 women conceived 4 times.
Among the women who conceived, 60% of the pregnancies resulted in live births. Seventeen (20%) foetal losses occurred in the first trimester; 3 losses occurred in the second trimester. Four therapeutic abortions were performed.
[Presentation title: Outcomes of 81 Pregnancies Following Radical Trachelectomy for the Treatment of Early-Stage Cervical Cancer. Abstract 211]
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