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Neoadjuvant chemotherapy (NCH) followed by abdominal radical trachelectomy (ART) in cervical cancer: long term follow up results of the Buenos Aires experience

Objectives: To analyze the long term follow up results of NCH followed by art in stages ib1 >2 cm and <4 cm squamous cervical carcinomas.

Methods: Prospective trial over 27 pts. submitted to an art between 10/04-10/15. In five cases stages ib1, (tumor >2 & <4 cm), underwent platinum based NCH. They were staged under figo´s staging system. MRI scan and hysteroscopy were performed before and after NCH as presurgical staging studies. Patients were included by the intention to treat. The surgery was performed 1 month after the last cycle of NCH. The art was sparing the uterine arteries and hypogastric plexus and was performed always by the same surgical team. Long term follow up results and survival rates were analyzed.

 Results: Median age: 27, 5 years old. The art could be successfully performed in 4/5 cases. Toxicity: hematologic, grade 1; alopecia, grade 2. MRI and hysteroscopy confirmed the tumor response after NCH. Three women got pregnant, one of them, twice. Pregnancies were spontaneously conceived. Three deliveries by cesarean section at 35, 5 weeks were done, obtaining 3 healthy new-borns. One case of abortion. Neither complications were observed during the prenatal controls nor at and after the surgery. No case of corioamnionitis was registered. No neonatal adverse effects occurred related to the chemotherapy scheme given. OS and DFs: 100%. Follow-up: 8- 72 months. The follow up after births was 8 and 30 months, free of disease.

Conclusions: NCH followed by art, is obstetrically and oncologically safe. It could be taken into account for selected patients with stages ib1 with tumors between 2-4 cm.

 

Author(s): Alejandro Soderini, Alejandro Aragona, Evangelina Bonavía, Horacio Moschen, Martin Mendez, Rosa Garrido, Diana Martinez, Nicasio Cuneo.