CURRENT KNOWLEDGE ON FERTILITY-SPARING TREATMENT OF CERVICAL CANCER PATIENTS

Abstract

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 OF THE STUDY

To summarize the current knowledge on FST in women with early stage cervical cancer.

STUDY TYPE

Review article.

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 oncologic outcomes to radical treatment with significantly lower rates of perinatologic 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 perinatologic 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.