NEW OPPORTUNITIES FOR SURGICAL TREATMENT OF PATIENTS WITH INITIALLY UNRESECTABLE UTERINE CERVIX CANCE

A new multimodality approach has been developed for management of locally advanced cervical cancer, including neoadjuvant chemotherapy with chemoembolization of two uterine arteries, a subsequent brachytherapy treatment at a dose of 10 Gy and type III hysterectomy or pelvic exenteration; this approach has made it possible to attain tumor resectability in 83.3 % of the cases, to avoid severe toxic, intraoperative and postoperative morbidities with a 90.5 % radicality of surgical intervention. This method produces satisfactory rates of 3-year overall observed survival, recurrence-free survival and metastasis-free survival being 82.3 %, 84.6 % and 88.4 % respectively

SHORT-TERM RESULTS OF SURGICAL INTERVENTION AFTER NEOADJUVANT MULTIDRUG CHEMOTHERAPY WITH SELECTIVE CHEMOEMBOLIZATION OF UTERINE ARTERIES IN PATIENTS WITH INITIALLY UNRESECTABLE CERVIX UTERI CANCER

Due to the poor outcomes of treatment for locally advanced cervix uteri cancer (CUC), new multimodality treatment modes have been recently sought for this patient population, by using neoadjuvant multidrug chemotherapy (MDCT) prior to surgical intervention. Many investigators are inclined to consider this approach to be an alternative to the standard treatment, although a number of issues, among them optimal combination of chemical drugs, are not settled yet.This study has evaluated the short-term results of MDCT with selective chemoembolization of uterine arteries with gemcitabine in 22 CUC patients treated at the N.N. Alexandrov Republican Research-and-Practical Center of Oncology and Medical Radiology in 2007-2009. MDCT courses have been noted to be satisfactorily tolerated, without causing severe adverse reactions. Neoadjuvant treat- ments have provided tumor resectability in 90.9% of the patients, the radicability index being 85%

Analysis of risk factors for recurrence in cervical cancer patients after fertility-sparing treatment: The FERTIlity Sparing Surgery retrospective multicenter study

Background: Fertility-sparing treatment in patients with cervical cancer should, in principle, follow identical algorithms to that in patients without future reproductive plans. In recent years, a trend toward nonradical procedures, such as conization or simple trachelectomy, has become apparent in medical literature, because of their associations with better pregnancy outcomes. However, the published reports included small numbers of patients and heterogenous treatment strategies to ascertain the safety of such approaches. Objective: This study aimed to collect multi-institutional data regarding the oncological outcomes after fertility-sparing treatment in patients with cervical cancer and to identify prognostic risk factors, including the influence of the radicality of individual cervical procedures. Study design: Patients aged 18 to 40 years with International Federation of Gynecology and Obstetrics 2018 stage IA1 with positive lymphovascular space invasion or ≥IA2 cervical cancer who underwent any type of fertility-sparing procedure were eligible for this retrospective observational study, regardless of their histotype, tumor grade, and history of neoadjuvant chemotherapy. Associations between disease- and treatment-related characteristics with the risk of recurrence were analyzed. Results: A total of 733 patients from 44 institutions across 13 countries were included in this study. Almost half of the patients had stage IB1 cervical cancer (49%), and two-thirds of patients were nulliparous (66%). After a median follow-up of 72 months, 51 patients (7%) experienced recurrence, of whom 19 (2.6%) died because of the disease. The most common sites of recurrence were the cervix (53%) and pelvic nodes (22%). The risk of recurrence was 3 times higher in patients with tumors >2 cm in size than in patients with smaller tumors, irrespective of the treatment radicality (19.4% vs 5.7%; hazard ratio, 2.982; 95% confidence interval, 1.383-6.431; P=.005). The recurrence risk in patients with tumors ≤2 cm in size did not differ between patients who underwent radical trachelectomy and patients who underwent nonradical (conization and simple trachelectomy) cervical procedures (P=.957), regardless of tumor size subcategory (<1 or 1-2 cm) or lymphovascular space invasion. Conclusion: Nonradical fertility-sparing cervical procedures were not associated with an increased risk of recurrence compared with radical procedures in patients with tumors ≤2 cm in size in this large, multicenter retrospective study. The risk of recurrence after any type of fertility-sparing procedure was significantly greater in patients with tumors >2 cm in size. Keywords: cervical cancer; conization; fertility-sparing treatment; recurrence; trachelectomy