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VRT May Preserve Fertility in Younger Cervical Ca Patients


 

TAMPA — Vaginal radical trachelectomy is a safe and effective option for preserving fertility in young women with early-stage cervical cancer, according to a review of outcomes in 113 patients.

A review of consecutive patients who underwent vaginal radical trachelectomy (VRT) between October 1991 and October 2007 showed that, at 74 months, disease-free survival was greater than 95%, and 87 pregnancies had occurred in 51 of the 113 women, Dr. Marie Plante reported in a poster at the annual meeting of the Society of Gynecologic Oncologists.

Thirty-one women had one pregnancy, nine had two pregnancies, six had three pregnancies, and five had four pregnancies during the study period. There were 58 third-trimester deliveries; 17 pregnancies ended in miscarriage in the first trimester, and 3 ended in miscarriage in the second trimester. Four women had therapeutic abortions, and five women were pregnant at the time of the report, Dr. Plante said.

Of those who delivered during the third trimester, 3 delivered prior to 32 weeks' gestation, 8 delivered between 32 and 37 weeks, and 47 delivered after 37 weeks.

VRT in this study was used in patients who desired to preserve fertility and who were under the age of 45 years. However, a history of infertility and advanced maternal age are not considered absolute contraindications to the procedure, noted Dr. Plante of Laval University, Quebec City.

The patients had International Federation of Gynecology and Obstetrics stage IA1 with vascular space involvement, IA2, or IB1 disease; squamous or adenocarcinoma histology; lesion size of 2-cm diameter or less; and limited endocervical involvement.

VRT was preceded by laparoscopic sentinel node mapping and bilateral pelvic node dissection, and sentinel nodes were sent for frozen section. VRT was abandoned if the nodes were positive or if extensive endocervical involvement was found.

Neoadjuvant chemotherapy was used in three patients for locally advanced disease. Each received three cycles of chemotherapy with paclitaxel, ifosfamide, and platinum, followed by VRT, node mapping, and dissection. Of these patients, two had residual dysplasia, and all had negative lymph nodes.

One of the patients who received neoadjuvant chemotherapy delivered two term babies (1 year apart), one patient was infertile because of cervical stenosis and transient ovarian failure (but she conceived with intrauterine insemination and Clomid and delivered at 36 weeks' gestation), and one was infertile because of ovarian failure and was unable to conceive.

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