Expanding the Indications for Radical Trachelectomy: A Report on 29 Patients With Stage IB1 Tumors Measuring 2 to 4 Centimeters. Issue 6 (1st July 2013)

• Record Type: Journal Article
• Authors: Wethington, Stephanie L.; Sonoda, Yukio; Park, Kay J.; Alektiar, Kaled M.; Tew, William P.; Chi, Dennis S.; Leitao, Mario M.; Jewell, Elizabeth L.; Barakat, Richard R.; Abu-Rustum, Nadeem R.
• Is Part Of: International journal of gynecological cancer. Volume 23:Issue 6(2013)
• Page Start: 1092
• Page End: 1098
• Publication Date: 2013-07-01
• Subjects: Trachelectomy -- Cervical cancer -- Fertility preservation; Generative organs, Female -- Cancer -- Periodicals; 616.99465
• DOI: 10.1097/IGC.0b013e318296034e
• Languages: English
• ISSNs: 1048-891X

Abstract

Abstract : Objectives: Radical trachelectomy has enabled select women with stage I cervical cancer to maintain fertility after treatment. Tumor size greater than 2 cm has been considered a contraindication, and those patients denied trachelectomy. We report our trachelectomy experience with tumors measuring 2 to 4 cm. Methods: We retrospectively reviewed the medical records of all patients planned for fertility-sparing radical trachelectomy. Largest tumor dimension was determined by physical examination, preoperative magnetic resonance imaging, or pathologic evaluation. No patient received neoadjuvant chemotherapy. Results: Twenty-nine (26%) of 110 patients had stage IB1 disease with tumors 2 to 4 cm. Median age was 31 years (range, 22–40 years), and 83% were nulliparous. Thirteen patients (45%) had squamous cell carcinoma, 12 patients (41%) had adenocarcinoma, and 4 patients (14%) had adenosquamous carcinoma. Thirteen (45%) of 29 patients had positive pelvic nodes. All para-aortic nodes were negative. Owing to intraoperative frozen section, 13 patients (45%) underwent immediate hysterectomy and 1 patient (3%) definitive chemoradiation. Owing to high-risk features on final pathology, 6 patients (21%) who had retained their uterus received chemoradiation. Nine patients (31%) underwent a fertility-sparing procedure. At a median follow-up of 44 months (range, 1–90 months), there was one recurrence. Conclusions: Expanding radical trachelectomy inclusion criteria to women with 2- to 4-cm tumors allows for a fertility-sparing procedure in 30% of patients who would otherwise have been denied the option, with no compromise in oncologic outcome.