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Pregnancy after lymphadenectomy and neoadjuvant chemotherapy followed by radical vaginal trachelectomy in FIGO stage IB1 cervical cancer.

AbstractOBJECTIVE:
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.
AuthorsElisabeth Gottschalk, Mandy Mangler, Achim Schneider, Christhardt Koehler, Malgorzata Lanowska
JournalFertility and sterility (Fertil Steril) Vol. 95 Issue 7 Pg. 2431.e5-7 (Jun 2011) ISSN: 1556-5653 [Electronic] United States
PMID21349513 (Publication Type: Case Reports, Journal Article)
CopyrightCopyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.
Chemical References
  • Paclitaxel
  • Cisplatin
Topics
  • Adult
  • Antineoplastic Combined Chemotherapy Protocols (adverse effects, therapeutic use)
  • Carcinoma, Adenosquamous (pathology, therapy)
  • Chemotherapy, Adjuvant
  • Cisplatin (administration & dosage)
  • Female
  • Fertility (drug effects)
  • Gynecologic Surgical Procedures
  • Humans
  • Laparoscopy
  • Live Birth
  • Lymph Node Excision (methods)
  • Neoadjuvant Therapy
  • Neoplasm Staging
  • Paclitaxel (administration & dosage)
  • Pregnancy
  • Treatment Outcome
  • Uterine Cervical Neoplasms (pathology, therapy)

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