Current knowledge on fertility-sparing treatment of cervical cancer patients

Czech version

Authors: L. Fricová; J. Sláma
Authors‘ workplace: Gynekologicko-porodnická klinika 1. LF UK a VFN v Praze
Published in: Ceska Gynekol 2022; 87(5): 362-370
Category: Review Article
doi: https://doi.org/10.48095/cccg2022362

Overview

Introduction: Cervical cancer directly affects the reproductive function of women of childbearing age. Up to one-third of the disease is diagnosed in women younger than 45 years of age, who may still have open reproductive plans. Therefore, in recent years, there has been increasing interest in performing fertility-sparing treatment (FST), which aims to preserve fertility while achieving the same oncologic safety as radical surgical treatment. Objective: To summarize the current knowledge on FST in women with early stages of cervical cancer. Methods: Review of published literature on the topic using medical databases. Results: FST is reserved for patients with HPV-associated cervical cancer up to stage IB with negative nodes. Conservative procedures (conization and simple vaginal trachelectomy) and radical trachelectomy are available. Conservative procedures for tumors ≤ 2 cm have comparable oncological outcomes as radical treatment with a significantly lower rate of perinatological complications. On average, 55% of patients become pregnant after treatment and of these, on average 70% give birth to a live newborn. Approximately 38% of deliveries are preterm, most often after radical trachelectomy. The most common postoperative complication with direct impact on fertility is cervical stenosis. Conclusion: In a selected group of patients with tumors up to 2 cm, FST is a safe procedure with good perinatological outcomes. However, it remains unclear whether it is safe to offer this treatment to patients with larger tumors. The use of neoadjuvant chemotherapy followed by conservative surgery is a promising approach but requires further validation in clinical trials.

Keywords:

cervical cancer – trachelectomy – fertility-sparing treatment – conization

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