Setting & Treatment
In our hospital, fertility-sparing treatment options for cervical cancer
include VRT with Sentinel Node Procedure (SNP) and Pelvic Lymph Node
Dissection (PLND), radical hysterectomy (RH) with ovarian preservation
and fertility preservation (FP) procedures prior to (chemo)radiotherapy.
After standardized diagnostic workup including medical history, physical
examination, laboratory tests, MR-imaging and histopathological
analysis, an individualized treatment plan was made during weekly
multidisciplinary treatment meetings. Staging was done according to the
International Federation of Obstetrics and Gynecology 2018
classification 6. Available treatment options
included:
1) VRT with laparoscopic or robotic SNP and PLND was indicated in
IA2-IB1 tumors measuring ≤2 cm as recommended by international
guidelines 6, 10. Our surgical technique was
previously described by 7, 11 and included SNP with
frozen section (FS) analyses, complete PLND and a vaginal radical
trachelectomy. A 2-step procedure consisting of a separate laparoscopic
or robotic SNP and PLND procedure with serial sectioning was performed
in patients with an estimated risk of lymph node (LN) positivity of
>10% to rule out lymph node metastases. In absence of LN
metastases, a VRT was performed in a second session. In these cases the
FS was not performed and final histopathology determines whether or not
the VRT was performed or chemoradiotherapy was required. A complementary
radical hysterectomy was performed in presence of positive or close
surgical margins and adjuvant chemoradiation was recommended in case of
positive lymph nodes. Neo-adjuvant chemotherapy followed by VRT was
performed on an individualized shared decision making basis.
2) Robot-assisted radical hysterectomy with SNP and PLND was indicated
in FIGO stage IB2 and IIA1 disease 6. As previously
described, first the SNP was performed and sent for FS analyses before
the PLND was completed using the da Vinci robot 12.In
absence of lymph node metastases, a radical hysterectomy was performed.
Adjuvant radiotherapy was indicated in presence of deep cervical stromal
invasion, lymphovascular space invasion (LVSI) and large (>
4cm) tumor size 13, 14. Adjuvant chemoradiotherapy was
recommended for patients with LN metastases or (microscopic) parametrial
involvement 14.
3) For patients with stage IB3 to IVA stage disease, treatment consisted
of concurrent external beam chemoradiotherapy followed by MRI guided
brachytherapy performed by a radiation oncologist 15.
Routine follow-up visits were performed every 3 months for the first
year, every 4 months for the second year and biannually for the last
three years.