Pattern of Cancer Recurrence in 320 Patients After Radical Vaginal Trachelectomy

Mangler, Mandy MD; Lanowska, Malgorzata MD; Köhler, Christhardt MD; Vercellino, Filiberto MD; Schneider, Achim MD; Speiser, Dorothee MD

International Journal of Gynecological Cancer:
doi: 10.1097/IGC.0000000000000012
Cervical Cancer
Abstract

Objective: The oncological outcome regarding disease-free survival and overall survival after radical vaginal trachelectomy (RVT) is the same as the rates after radical hysterectomy. We aim to analyze predictive and risk factors and death in patients with cervical cancer undergoing fertility preservation by laparoscopic lymphadenectomy and RVT.

Methods: Three hundred twenty patients with cervical cancer underwent RVT between March 1995 and February 2013. In our study, we examined recurrence rates analyzed by risk factors. We classified the presence of lymphovascular space invasion, depth of tumor infiltration, tumor size, and tumor grading as risk factors. The mean follow-up time was 48 months.

Results: Ten of the 320 patients had cancer recurrence. Recurrence appeared at a mean time of 26.1 months (3–108 months) after RVT. Five patients died within 8.8 months (4–15 months) after recurrence was diagnosed. Two of these 5 patients had distant metastasis at the time of recurrence. Five patients were treated successfully by surgery, and 4 patients were treated successfully by chemotherapy. The mean follow-up after the recurrence of these 5 patients is 76 months (6–120 months). None of the 10 patients with recurrences in our series showed significant high-risk factors.

Conclusion: There seems to be no pattern in the recurrence of cancer after RVT. It is strictly mandatory to follow up the patients closely every 3 months after RVT to diagnose recurrence at an early stage so therapeutic options such as chemoradiation are still available. Once distant metastasis occurs, prognosis is not good.

Author Information

Department of Gynecology, Charité–University Medicine Berlin, Berlin, Germany.

Address correspondence and reprint requests to Mandy Mangler, MD, Department of Gynecology, Charité Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117 Berlin, Germany. E-mail: mandy.mangler@charite.de.

Achim Schneider receives honoraria for counseling and support for his fellowship program from Karl Storz, Tuttlingen, Germany.

The other authors declare no conflicts of interest.

Received July 12, 2013

Accepted August 27, 2013

© 2014 by the International Gynecologic Cancer Society and the European Society of Gynaecological Oncology.