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

Abstract

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.

• Authors: Elisabeth Gottschalk, Mandy Mangler, Achim Schneider, Christhardt Koehler, Malgorzata Lanowska
• Journal: Fertility and sterility (Fertil Steril) Vol. 95 Issue 7 Pg. 2431.e5-7 (Jun 2011) ISSN: 1556-5653 [Electronic] United States
• PMID: 21349513 (Publication Type: Case Reports, Journal Article)
• Copyright: Copyright © 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)