Fertility and sterility · 2011
Pregnancy after lymphadenectomy and neoadjuvant chemotherapy followed by radical vaginal trachelectomy in FIGO stage IB1 cervical cancer.
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Gottschalk Elisabeth, Mangler Mandy, Schneider Achim, Koehler Christhardt, Lanowska Malgorzata
Аннотация
OBJECTIVE: To report a case of full-term delivery after laparoscopic lymphadenectomy and neoadjuvant chemotherapy followed by radical vaginal trachelectomy in bulky stage IB1 cervical cancer.
DESIGN: Case report.
SETTING: University hospital.
PATIENT(S): A 27-year-old woman with adenosquamous cervical cancer stage IB1 (4 cm in diameter) that was diagnosed in December 2005. She expressed a wish for fertility-sparing treatment.
INTERVENTION(S): A laparoscopic pelvic and para-aortic lymphadenectomy was performed and showed no evidence of lymphatic metastasis. The patient subsequently received chemotherapy with Paclitaxel 200 mg/m2 and Cisplatin 100 mg/m2. The treatment cycle was repeated after 3 weeks with Cisplatin reduced to 50 mg/m2, because of creatinine-increase. Radical vaginal trachelectomy was then performed. After histologic examination, carcinoma of only 2 mm in diameter was found in the final specimen.
MAIN OUTCOME MEASURE(S): Oncologic and fertility outcome after neoadjuvant chemotherapy and radical vaginal trachelectomy.
RESULT(S): The patient resumed a normal menstrual pattern 6 weeks after surgery. In December 2008, she conceived and carried and infant to full term. Antenatally, she reported no problems during pregnancy except for gestational insulin-dependent diabetes. She gave birth to a baby boy at 38 weeks' gestation by caesarean section. The newborn (weight, 3500 g; length, 52 cm; Apgar scores, 5/8/10; pH value, 7.28) was monitored in a neonatal ward for 24 hours. The patient is currently under outpatient review and has had 5 years of follow-up with no evidence of recurrence.
CONCLUSION(S): Neoadjuvant chemotherapy followed by a fertility-sparing surgery may become a valuable option for women with bulky-stage cervical cancer who wish to preserve their fertility potential.
DESIGN: Case report.
SETTING: University hospital.
PATIENT(S): A 27-year-old woman with adenosquamous cervical cancer stage IB1 (4 cm in diameter) that was diagnosed in December 2005. She expressed a wish for fertility-sparing treatment.
INTERVENTION(S): A laparoscopic pelvic and para-aortic lymphadenectomy was performed and showed no evidence of lymphatic metastasis. The patient subsequently received chemotherapy with Paclitaxel 200 mg/m2 and Cisplatin 100 mg/m2. The treatment cycle was repeated after 3 weeks with Cisplatin reduced to 50 mg/m2, because of creatinine-increase. Radical vaginal trachelectomy was then performed. After histologic examination, carcinoma of only 2 mm in diameter was found in the final specimen.
MAIN OUTCOME MEASURE(S): Oncologic and fertility outcome after neoadjuvant chemotherapy and radical vaginal trachelectomy.
RESULT(S): The patient resumed a normal menstrual pattern 6 weeks after surgery. In December 2008, she conceived and carried and infant to full term. Antenatally, she reported no problems during pregnancy except for gestational insulin-dependent diabetes. She gave birth to a baby boy at 38 weeks' gestation by caesarean section. The newborn (weight, 3500 g; length, 52 cm; Apgar scores, 5/8/10; pH value, 7.28) was monitored in a neonatal ward for 24 hours. The patient is currently under outpatient review and has had 5 years of follow-up with no evidence of recurrence.
CONCLUSION(S): Neoadjuvant chemotherapy followed by a fertility-sparing surgery may become a valuable option for women with bulky-stage cervical cancer who wish to preserve their fertility potential.