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Open Access 05-09-2022 | Fertility | Gynecologic Oncology

Fertility-Sparing Treatment for Early-Stage Cervical Cancer ≥ 2 cm: A Problem with a Thousand Nuances—A Systematic Review of Oncological Outcomes

Authors: Carlo Ronsini, MD, Maria Cristina Solazzo, MD, Nicolò Bizzarri, MD, Domenico Ambrosio, MD, Marco La Verde, MD, Marco Torella, MD, Raffaela Maria Carotenuto, MD, Luigi Cobellis, MD, Nicola Colacurci, MD, Pasquale De Franciscis, MD

Published in: Annals of Surgical Oncology | Issue 13/2022

Abstract

Background

Fertility-sparing treatments (FSTs) have played a crucial role in the management of early-stage cervical cancer (ECC). The guidelines have recognized various approaches, depending on the tumor stage and other risk factors such as histotype and lymphovascular positivity. Much more debate has centered around the boundary within which these treatments should be considered. Indeed, these are methods to be reserved for ECC, but tumor size may represent the most significant limitation. In particular, there is no consensus on the strategy to be adopted in the case of ECC ≥ 2 cm. Therefore, this systematic review was to collect the literature evidence regarding the management of these patients.

Methods

Following the recommendations in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, we systematically searched the Pubmed and Scopus databases was conducted in April 2022, from the date of the first publication. We made no limitation on the country. We included all studies containing data on disease-free survival, overall survival, recurrence rate (RR), or complete response rate (CRR) to chemotherapy.

Results

Twenty-six studies fulfilled the inclusion criteria, and 691 patients were analyzed regarding FST. Surgery-based FST showed an RR of between 0 and 42.9%, which drops to 12.9% after excluding the vaginal or minimally invasive approaches. Furthermore, papers regarding FST based on the neoadjuvant chemotherapy (NACT) approach showed a CRR of between 21.4 and 84.5%, and an RR of between 0 and 22.2%

Conclusion

This paper focused on the significant heterogeneity present in the clinical management of FST of ECC ≥ 2 cm. Nevertheless, from an oncological point of view, approaches limited to the minimally invasive or vaginal techniques showed the highest RR. Vice versa, the lack of standardization of NACT schemes and the wealth of confounders to be attributed to the histological features of the tumor make it difficult, if not impossible, to set a standard of treatment.

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Title: Fertility-Sparing Treatment for Early-Stage Cervical Cancer ≥ 2 cm: A Problem with a Thousand Nuances—A Systematic Review of Oncological Outcomes
Authors: Carlo Ronsini, MD
Maria Cristina Solazzo, MD
Nicolò Bizzarri, MD
Domenico Ambrosio, MD
Marco La Verde, MD
Marco Torella, MD
Raffaela Maria Carotenuto, MD
Luigi Cobellis, MD
Nicola Colacurci, MD
Pasquale De Franciscis, MD
Publication date: 05-09-2022
Publisher: Springer International Publishing
Keywords: Fertility
Cervical Cancer
Cervical Cancer
Conisation
Lymphadenectomy
Radical Trachelectomy
Published in: Annals of Surgical Oncology / Issue 13/2022
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-022-12436-w

At a glance: The STEP trials

Springer Medicine

Fertility-Sparing Treatment for Early-Stage Cervical Cancer ≥ 2 cm: A Problem with a Thousand Nuances—A Systematic Review of Oncological Outcomes

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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