• Main
  • Publications
  • The role of neoadjuvant chemotherapy in fertility-sparing treatment of patients with cervical cancer with tumor sizes over 2 cm

The role of neoadjuvant chemotherapy in fertility-sparing treatment of patients with cervical cancer with tumor sizes over 2 cm

September 19, 2025
863
Obstetrics and Gynecology
Oncology, Hematology
Renkas O.P.
Svintsitsky V.S.
УДК:  618 (618.146-006.6-085.28)
DOI:  10.32471/umj.1680-3051.268951
Keywords :
cervical cancer,
fertility-preserving treatment
Specialities :
Obstetrics and Gynecology
Oncology, Hematology
Resume

Purpose: to evaluate the feasibility, safety, and oncological outcomes in patients with cervical cancer with tumor size >2 cm who received neoadjuvant chemotherapy followed by fertility-sparing treatment.

Materials and methods. From January 2018 to January 2025, 25 patients diagnosed with cervical cancer stage 1B2–ІІА2 (FIGO 2018) were included in the study. The mean age of the patients at diagnosis was 28 years (range 16–36 years). Clinical cases of patients with cervical cancer 2–6 cm who were selected to receive neoadjuvant chemotherapy before fertility-sparing treatment (abdominal radical trachelectomy, vaginal radical trachelectomy, conization with pelvic lymphadenectomy) were analyzed.

Results. Surgical and clinical outcomes have examined together with radiological and pathological findings. 17 patients (68%) had squamous cell carcinoma, 8 patients (32%) had adenocarcinoma, and no cases had adenosquamous carcinoma. The mean tumor size before chemotherapy was 32 mm (range 25–52 mm), and after chemotherapy was 9 mm (range 0–27 mm). Patients received neoadjuvant chemotherapy with cisplatin 70 mg/m2 and paclitaxel 175 mg/m2 or carboplatin AUC5-6 and paclitaxel 175 mg/m2 every 3 weeks. Fertility was successfully preserved in 23 of 25 (96%) patients. One patient had stable disease after three cycles of chemotherapy and was therefore not eligible for fertility-sparing surgery, and another patient had positive lymph nodes verified by histological examination, so she underwent chemoradiation therapy. One of 25 (4%) patients experienced disease recurrence.

Conclusion. Neoadjuvant chemotherapy followed by fertility-sparing surgery may be a feasible and safe option for selected patients with cervical cancer with tumors >2 cm.

References

  • 1. Sung H., Ferlay J., Siegel R.L. et al. (2021) Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. Cancer J. Clin., 3: 209–249. doi: 10.3322/caac.21660.
  • 2. Cibula D., Raspollini M.R., Planchamp F. et al. (2023) ESGO/ESTRO/ESP guidelines for the management of patients with cervical cancer — Update 2023. Int. J. Gynecol. Cancer, 33(5): 649–666. doi: 10.1136/ijgc-2023-004429.
  • 3. National Comprehensive Cancer Network (NCCN) NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®): Cervical Cancer. Version 4.2025.
  • 4. Tseng J.H., Aloisi A., Sonoda Y. et al. (2018) Long-term oncologic outcomes of uterine-preserving surgery in young women with stage IB1 cervical cancer. Int. J. Gynecol. Cancer, 28(7): 1350–1359. doi: 10.1097/IGC.0000000000001319.
  • 5. Li P., Fang Z., Li W. et al. (2024) Impact of neoadjuvant chemotherapy on the postoperative pathology of locally advanced cervical squamous cell carcinomas: 1:1 propensity score matching analysis. Eur. J. Surg. Oncol., 47(5): 1069–1074. doi: 10.1016/j.ejso.2024.108572.
  • 6. Plante M. (2013) Evolution in fertility-preserving options for early-stage cervical cancer: radical trachelectomy, simple trachelectomy, neoadjuvant chemotherapy. Int. J. Gynecol. Cancer, 23(6): 982–989. doi: 10.1097/IGC.0b013e318295906b.
  • 7. van Gent M.D.J.M., van den Haak L.W., Gaarenstroom K.N. et al. (2014) Nerve-sparing radical abdominal trachelectomy versus nerve-sparing radical hysterectomy in early-stage (FIGO IA2–IB) cervical cancer: a comparative study on feasibility and outcome. Int. J. Gynecol. Cancer, 24(4): 735–743. doi: 10.1097/IGC.0000000000000114.
  • 8. Zusterzeel P.L., Pol F.J., van Ham M. et al. (2016) Vaginal radical trachelectomy for early-stage cervical cancer: Increased recurrence risk for adenocarcinoma. Int. J. Gynecol. Cancer, 26(7): 1293–1299. doi: 10.1097/IGC.0000000000000763.
  • 9. Dargent D., Brun J.L., Roy M. et al. (1994) Pregnancies following radical trachelectomy for invasive cervical cancer. Gynecol. Oncol., 13: 683–690.
  • 10. Einstein M.H., Park K.J., Sonoda Y. et al. (2009) Radical vaginal versus abdominal trachelectomy for stage IB1 cervical cancer: a comparison of surgical and pathologic outcomes. Gynecol. Oncol., 112(1): 73–77. doi: 10.1016/j.ygyno.2008.09.007.
  • 11. Shipko F., Renkas O., Svintsitskyi V. et al. (2022) Treatment option to the fertility-sparing radical trachelectomy after neoadjuvant chemotherapy in patients with cervical cancer with tumor size >2cm. Exp. Oncol., 44(3): 254–258. doi.org/10.32471/exp-oncology.2312-8852.vol-44-no-3.
  • 12. van de Kol K.G.C., Vergeldt T.F.M., Bekkers R.L.M. (2019) Abdominal radical trachelectomy versus chemotherapy followed by vaginal radical trachelectomy in stage 1B2 (FIGO 2018) cervical cancer. A systematic review on fertility and recurrence rates. Gynecol. Oncol., 155 (3): 515–521. doi: 10.1016/j.ygyno.2019.09.025.
  • 13. Plante M., Lau S., Brydon L. et al. (2006) Neoadjuvant chemotherapy followed by vaginal radical trachelectomy in bulky stage IB1 cervical cancer: Case report. Gynecol. Oncol., 101(2): 367–370. doi: 10.1016/j.ygyno.2006.02.001.
  • 14. Kim C.H., Abu-Rustum N.R., Chi D.S. et al. (2012) Reproductive outcomes of patients undergoing radical trachelectomy for early-stage cervical cancer. Gynecol. Oncol., 125(3): 585–588. doi: 10.1016/j.ygyno.2012.03.014.
  • 15. Wethington S.L., Sonoda Y., Park K.J. et al. (2013) Expanding the indications for radical trachelectomy: a report on 29 patients with stage IB1 tumors measuring 2 to 4 centimeters. Int. J. Gynecol. Cancer, 23(6): 1092–1098. doi: 10.1097/IGC.0b013e318296034e.
  • 16. Maneo A., Chiari S., Bonazzi C. et al. (2008) Neoadjuvant chemotherapy and conservative surgery for stage IB1 cervical cancer. Gynecol. Oncol., 111(3): 438–443. doi: 10.1016/j.ygyno.2008.08.023.
  • 17. Marchiolè P., Ferraioli D., Moran E. et al. (2018) NACT and laparoscopic-assisted radical vaginal trachelectomy in young patients with large (2-5 cm) high risk cervical cancers: Safety and obstetrical outcome. Surg. Oncol., 27(2): 236–244. doi: 10.1016/j.suronc.2018.04.006.
  • 18. Lanowska M., Mangler M., Speiser D. et al. (2014) Radical vaginal trachelectomy after laparoscopic staging and neoadjuvant chemotherapy in women with early-stage cervical cancer over 2 cm: Oncologic, fertility, and neonatal outcome in a series of 20 patients. Int. J. Gynecol. Cancer, 24(3): 586–593. doi: 10.1097/IGC.0000000000000080.
  • 19. Robova H., Pluta M., Hrehorcak M. et al. (2008) High-dose density chemotherapy followed by simple trachelectomy: full-term pregnancy. Int. J. Gynecol. Cancer, 18(6): 1367–1371. doi: 10.1111/j.1525-1438.2007.01178.x.
  • 20. Robova H., Halaska M.J., Pluta M. et al. (2014) Oncological and pregnancy outcomes after high-dose density neoadjuvant chemotherapy and fertility-sparing surgery in cervical cancer. Gynecol Oncol., 135(2): 213–216. doi: 10.1016/j.ygyno.2014.08.021.
  • 21. Plante M., van Trommel N., Lheureux S. et al. (2019) 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, 29(5): 969–975. doi: 10.1136/ijgc-2019-000398.

«Morion» publishing house

Editorial office and publisher: 02072, Kyiv, ave. Bazhana 10A

+380 (44) 585-97-10

Limitation of liability

Professional scientific and practical edition for health care specialists