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. 2023 Sep;30(9):5587-5596.
doi: 10.1245/s10434-023-13542-z. Epub 2023 Jun 1.

Fertility-Sparing Treatment for Early-Stage Cervical Cancer ≥ 2 cm: Can One Still Effectively Become a Mother? A Systematic Review of Fertility Outcomes

Carlo Ronsini  1 , M C Solazzo  2 , R Molitierno  2 , P De Franciscis  2 , F Pasanisi  2 , L Cobellis  2 , N Colacurci  2
Affiliations

Fertility-Sparing Treatment for Early-Stage Cervical Cancer ≥ 2 cm: Can One Still Effectively Become a Mother? A Systematic Review of Fertility Outcomes

Carlo Ronsini et al. Ann Surg Oncol. 2023 Sep.

Abstract

Background: Fertility-sparing treatments (FSTs) have played a crucial role in the management of early-stage cervical cancer (ECC); however, there is currently no standard of care for women with ECC ≥ 2 cm who wish to preserve their fertility. The current orientation of the scientific community comprises upfront surgical techniques and neoadjuvant chemotherapy (NACT) followed by minor surgery such us conization. However these approaches are not standardized. This systematic review aimed to collect the evidence in the literature regarding the obstetric outcomes of the different techniques for applying FSTs in ECC ≥ 2 cm.

Methods: A systematic review was performed in September 2022 using the Pubmed and Scopus databases, from the date of the first publication. We included all studies containing data regarding pregnancy, birth, and preterm rates.

Results: Fifteen studies fulfilled the inclusion criteria, and 352 patients were analyzed regarding fertility outcomes. Surgery-based FST showed the pregnancy rate (22%), birth rate (11%), and preterm rate (10%). Papers regarding FST using the NACT approach showed a pregnancy rate of 44%, with a birth rate of 45% in patients who managed to get pregnant. The preterm rate amounted to 44%, and pregnancy rates and birth rates were significantly different between the two groups (p < 0.001).

Conclusion: Fertility preservation in patients with ECC > 2 cm is challenging. The endpoint for evaluating the best treatment should include oncological and fertility outcomes together. From this prospective, NACT followed by less radical surgery could be a reasonable compromise.

Keywords: Birth rat; Cervical cancer; Fertility sparing treatment; Pre-term rate; Pregnancy rate; Trachelectomy.

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Figures

Fig. 1
Fig. 1
PRISMA flow diagram. PRISMA Preferred Reporting Items for Systematic Reviews and Meta-Analyses
See this image and copyright information in PMC

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