Evaluation of reproductive and oncological outcomes after fertility-sparing surgery in cervical cancer patients with tumor > 2 cm
Background/objectives: We aimed to evaluate the reproductive and oncological outcomes of patients who underwent fertility-sparing surgery (FSS) despite being considered suboptimal candidates due to tumor size > 2 cm with or without lymph node metastasis. Methods: Between September 2008 and Novemb...
Saved in:
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-02-01
|
| Series: | Gynecologic Oncology Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S235257892500013X |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1825206863102214144 |
|---|---|
| author | Kiarash Bahrehmand Dóra Vesztergom Barna Budai Dániel Lengyel Edina Lukács Zoltán Novák |
| author_facet | Kiarash Bahrehmand Dóra Vesztergom Barna Budai Dániel Lengyel Edina Lukács Zoltán Novák |
| author_sort | Kiarash Bahrehmand |
| collection | DOAJ |
| description | Background/objectives: We aimed to evaluate the reproductive and oncological outcomes of patients who underwent fertility-sparing surgery (FSS) despite being considered suboptimal candidates due to tumor size > 2 cm with or without lymph node metastasis. Methods: Between September 2008 and November 2021, 120 patients with early-stage cervical cancer patients who wished to preserve their fertility, were treated in our center. Out of these, 18 patients were not optimal candidates for FSS according to current guidelines. Despite our proposed radical treatment, these patients insisted on having a fertility-sparing treatment. The primary objective was to evaluate the reproductive outcomes including the method of conception, postoperative pregnancy rate, fertility preservation rate, live birth rate, and preterm delivery rate, while the secondary objective was to evaluate 5-year disease-free survival (DFS) and 5-year overall survival (OS). Results: Out of 18 patients, 5 had lymph node metastasis and 2 of them declined adjuvant chemoradiation. Fertility sparing treatment was successful in 14/18 (77.8 %) patients. Out of the 14, 64.3 % (9/14) tried to conceive, resulting in 2 successful deliveries after in vitro fertilization resulting a live birth rate of 22.2. After a median follow-up of 143.3 months (95 % CI 66–169), the 5-year DFS and OS were 83.3 % (66.1–100) and 93.3 % (80.7–100), respectively. Conclusions: This study highlights the possibility of FSS in patients with suboptimal tumor characteristics for fertility preservation while providing acceptable oncologic outcomes. We found that classical barriers to FSS can be challenged, balancing fertility preservation and oncological outcomes, and argue for personalized approaches to cervical cancer treatment, respecting patient priorities. Further prospective studies are warranted to establish the efficacy and safety of such approaches. |
| format | Article |
| id | doaj-art-415f54f964d74190850cc04189cd4f2d |
| institution | Kabale University |
| issn | 2352-5789 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Gynecologic Oncology Reports |
| spelling | doaj-art-415f54f964d74190850cc04189cd4f2d2025-02-07T04:47:50ZengElsevierGynecologic Oncology Reports2352-57892025-02-0157101688Evaluation of reproductive and oncological outcomes after fertility-sparing surgery in cervical cancer patients with tumor > 2 cmKiarash Bahrehmand0Dóra Vesztergom1Barna Budai2Dániel Lengyel3Edina Lukács4Zoltán Novák5Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary; Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary; Corresponding author at: National Institute of Oncology, Ráth Gy. u. 7-9, 1122 Budapest, Hungary.Department of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary; Doctoral School of Clinical Medicine, University of Szeged, Szeged, HungaryDepartment of Molecular Genetics, National Institute of Oncology, Budapest, HungaryDepartment of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary; Doctoral School of Clinical Medicine, University of Szeged, Szeged, HungaryDepartment of Gynecology, Hungarian National Institute of Oncology, Budapest, HungaryDepartment of Gynecology, Hungarian National Institute of Oncology, Budapest, Hungary; Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary; National Tumor Biology Laboratory, National Institute of Oncology, Budapest, HungaryBackground/objectives: We aimed to evaluate the reproductive and oncological outcomes of patients who underwent fertility-sparing surgery (FSS) despite being considered suboptimal candidates due to tumor size > 2 cm with or without lymph node metastasis. Methods: Between September 2008 and November 2021, 120 patients with early-stage cervical cancer patients who wished to preserve their fertility, were treated in our center. Out of these, 18 patients were not optimal candidates for FSS according to current guidelines. Despite our proposed radical treatment, these patients insisted on having a fertility-sparing treatment. The primary objective was to evaluate the reproductive outcomes including the method of conception, postoperative pregnancy rate, fertility preservation rate, live birth rate, and preterm delivery rate, while the secondary objective was to evaluate 5-year disease-free survival (DFS) and 5-year overall survival (OS). Results: Out of 18 patients, 5 had lymph node metastasis and 2 of them declined adjuvant chemoradiation. Fertility sparing treatment was successful in 14/18 (77.8 %) patients. Out of the 14, 64.3 % (9/14) tried to conceive, resulting in 2 successful deliveries after in vitro fertilization resulting a live birth rate of 22.2. After a median follow-up of 143.3 months (95 % CI 66–169), the 5-year DFS and OS were 83.3 % (66.1–100) and 93.3 % (80.7–100), respectively. Conclusions: This study highlights the possibility of FSS in patients with suboptimal tumor characteristics for fertility preservation while providing acceptable oncologic outcomes. We found that classical barriers to FSS can be challenged, balancing fertility preservation and oncological outcomes, and argue for personalized approaches to cervical cancer treatment, respecting patient priorities. Further prospective studies are warranted to establish the efficacy and safety of such approaches.http://www.sciencedirect.com/science/article/pii/S235257892500013XCervical cancerFertility-sparing surgeryRadical trachelectomyLymph node metastasisIn vitro fertilization |
| spellingShingle | Kiarash Bahrehmand Dóra Vesztergom Barna Budai Dániel Lengyel Edina Lukács Zoltán Novák Evaluation of reproductive and oncological outcomes after fertility-sparing surgery in cervical cancer patients with tumor > 2 cm Gynecologic Oncology Reports Cervical cancer Fertility-sparing surgery Radical trachelectomy Lymph node metastasis In vitro fertilization |
| title | Evaluation of reproductive and oncological outcomes after fertility-sparing surgery in cervical cancer patients with tumor > 2 cm |
| title_full | Evaluation of reproductive and oncological outcomes after fertility-sparing surgery in cervical cancer patients with tumor > 2 cm |
| title_fullStr | Evaluation of reproductive and oncological outcomes after fertility-sparing surgery in cervical cancer patients with tumor > 2 cm |
| title_full_unstemmed | Evaluation of reproductive and oncological outcomes after fertility-sparing surgery in cervical cancer patients with tumor > 2 cm |
| title_short | Evaluation of reproductive and oncological outcomes after fertility-sparing surgery in cervical cancer patients with tumor > 2 cm |
| title_sort | evaluation of reproductive and oncological outcomes after fertility sparing surgery in cervical cancer patients with tumor 2 cm |
| topic | Cervical cancer Fertility-sparing surgery Radical trachelectomy Lymph node metastasis In vitro fertilization |
| url | http://www.sciencedirect.com/science/article/pii/S235257892500013X |
| work_keys_str_mv | AT kiarashbahrehmand evaluationofreproductiveandoncologicaloutcomesafterfertilitysparingsurgeryincervicalcancerpatientswithtumor2cm AT doravesztergom evaluationofreproductiveandoncologicaloutcomesafterfertilitysparingsurgeryincervicalcancerpatientswithtumor2cm AT barnabudai evaluationofreproductiveandoncologicaloutcomesafterfertilitysparingsurgeryincervicalcancerpatientswithtumor2cm AT daniellengyel evaluationofreproductiveandoncologicaloutcomesafterfertilitysparingsurgeryincervicalcancerpatientswithtumor2cm AT edinalukacs evaluationofreproductiveandoncologicaloutcomesafterfertilitysparingsurgeryincervicalcancerpatientswithtumor2cm AT zoltannovak evaluationofreproductiveandoncologicaloutcomesafterfertilitysparingsurgeryincervicalcancerpatientswithtumor2cm |