Neoadjuvant chemotherapy and conservative surgery for stage IB1 cervical cancer.

Objectives: To assess the effectiveness of chemo-surgical conservative therapy for stage IB1 cervical tumors in patients desiring to preserve fertility.

Methods: From 1995 to April 2007 51 nulliparous patients with tumor
Results: Thirty women (59%) did not accept the conservative approach. In the remaining 21 patients median age was 30 years and median tumor size was 15 mm (range 10-30 mm). Adenocarcinoma was present in 12 cases (57%) and indifferentiated neoplasia in 10 (48%). Following neoadjuvant treatment, pathological complete response was observed in 5 cases, in situ or microinvasive residue in 12 and stromal invasion >3 mm in 4. Four women deemed ineligible for conservative surgery after chemotherapy and one refusing to preserve her genital apparatus underwent radical hysterectomy. After a median follow-up of 69 months no relapses were observed. Nine women attempted to conceive: ten pregnancies occurred in 6 patients and 9 live babies have been born, while one woman experienced a first-trimester miscarriage.

Conclusions: The high rate of pathological response confirms the effectiveness of the preoperative treatment for reducing the tumor volume allowing the removal only of a cervical cone instead of the entire cervix with cardinal ligaments as needed by radical trachelectomy. Successful pregnancies are possible after such integration.