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International Journal of Gynecological Cancer:
doi: 10.1097/IGC.0b013e31827ef759
Cervical Cancer

Analysis of a Continuous Series of 34 Young Patients With Early-Stage Cervical Cancer Selected for a Vaginal Radical Trachelectomy: Should “Staging” Conization Be Systematically Performed Before This Procedure?

Uzan, Catherine MD, PhD*†; Gouy, Sebastien MD*; Desroque, Delphine MD*; Pomel, Christophe MD, PhD; Duvillard, Pierre MD§; Balleyguier, Corrine MD; Haie-Meder, Christine MD; Morice, Philippe MD, PhD*#

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Abstract

Objective: Vaginal radical trachelectomy (VRT) is the most widely evaluated form of conservative management of young patients with early-stage (IB1) cervical cancer. Patients with nodal involvement or a tumor size greater than 2 cm are not eligible for such treatment. The aim of this study is to report the impact of a “staging” conization before VRT.

Methods: This is a retrospective study of 34 patients potentially selected for VRT for a clinical and radiologic cervical tumor less than 2 cm. Among them, 28 underwent finally a VRT (20 of them having a previous conization before this procedure) and 6 patients with macroscopic cervical cancer, confirmed by punch biopsies, “eligible” for VRT (<2 cm) had undergone “staging” conization (without further VRT) to confirm the tumor size and lymphovascular space involvement (LVSI) status.

Results: Six patients having “staging” conization before VRT had finally been deemed contraindications to VRT due to the presence of a histologically confirmed tumor greater than 2 cm and/or associated with multiple foci of LVSI. Among 28 patients who underwent VRT, 1 received adjuvant chemoradiation (this patient recurred and died of disease). Two patients treated with RVT (without postoperative treatment) recurred. Ten pregnancies (9 spontaneous and 1 induced) were observed in 9 patients. Among 4 patients with macroscopic “visible” tumor who do not underwent a “staging” conization before VRT, 2 recurred. Among 11 patients who underwent VRT and having LVSI, 3 recurred.

Conclusions: These results suggest that if a conization is not performed initially, it should then be included among the staging procedures to select patients for VRT.

Copyright © 2013 by IGCS and ESGO

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