{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T13:09:10Z","timestamp":1793192950020,"version":"4.5.0"},"reference-count":37,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2021,11,29]],"date-time":"2021-11-29T00:00:00Z","timestamp":1638144000000},"content-version":"vor","delay-in-days":567,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Standard treatment for International Federation of Gynecology and Obstetrics (FIGO) 2018 stage 1B2 cervical cancer (i.e., tumor size between 2 and 4 cm) is a radical hysterectomy (RH) with pelvic lymph node dissection (PLND). We evaluated the oncological and fertility outcomes treatment in patients receiving a fertility-sparing alternative consisting of neoadjuvant chemotherapy (NACT) followed by vaginal radical trachelectomy (VRT).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Patients with stage 1B2 cervical cancer who wished to preserve fertility were included from September 2009 to September 2018. NACT consisted of 6-week cycles of cisplatin or carboplatin with paclitaxel. If tumor size decreased to 2 cm or smaller, NACT was followed by a robot-assisted PLND and VRT.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Eighteen patients were included. Median follow-up time was 49.7 months (range 11.4\u2013110.8). Median tumor size was 32\u2009mm (range 22\u201340\u2009mm). Complete remission after NACT occurred in seven women. Four women had a poor response on NACT. Three underwent RH with PLND; one received chemoradiation after PLND instead of VRT because of positive lymph nodes. The remaining 14 patients received VRT 3\u20134\u2009weeks after NACT. Four recurrences occurred: three after NACT and VRT and one after NACT and RH. Median time to recurrence was 20.8 months (range 17.0\u2013105.7). Three recurrences occurred in women with adenocarcinoma with lymph vascular space invasion (LVSI). In four women fertility could not be preserved. To date, four women had six pregnancies, including three live births born at term, two first trimester miscarriages, and one currently ongoing pregnancy.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>NACT and VRT in women with stage 1B2 cervical cancer showed promising results. In 78% fertility was preserved. However, patients with poor response on NACT and with adenocarcinoma and\/or LVSI were possibly at risk for recurrence. Long-term results in relation to fertility and oncological outcome are needed to corroborate these findings.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Implications for Practice<\/jats:title>\n                  <jats:p>Standard treatment for women with International Federation of Gynecology and Obstetrics (FIGO) 2018 stage 1B2 cervical cancer (tumor size 2\u20134 cm) is a radical hysterectomy and pelvic lymph node dissection (PLND). However, many of these women are young and wish to preserve fertility. Data on fertility-sparing treatment options are sparse, but neoadjuvant chemotherapy followed by a vaginal radical trachelectomy and PLND could be an alternative. Since 2009 we performed an observational cohort study in which 18 women opted for this treatment in our center. In 14 women fertility could be preserved. In four patients the tumor recurred. In four women six pregnancies occurred. After careful selection this treatment could be a good fertility-sparing treatment option.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1634\/theoncologist.2020-0063","type":"journal-article","created":{"date-parts":[[2020,4,27]],"date-time":"2020-04-27T20:23:54Z","timestamp":1588019034000},"page":"e1051-e1059","source":"Crossref","is-referenced-by-count":33,"title":["Neoadjuvant Chemotherapy Followed by Vaginal Radical Trachelectomy as Fertility-Preserving Treatment for Patients with FIGO 2018 Stage 1B2 Cervical Cancer"],"prefix":"10.1093","volume":"25","author":[{"given":"Petra L.M.","family":"Zusterzeel","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johanna W.M.","family":"Aarts","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fraukje J.M.","family":"Pol","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petronella B.","family":"Ottevanger","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maaike A.P.C.","family":"van Ham","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,5,11]]},"reference":[{"key":"2021122510445082600_onco13339-bib-0001","author":"Cervical cancer"},{"key":"2021122510445082600_onco13339-bib-0002","doi-asserted-by":"crossref","first-page":"3262","DOI":"10.1016\/j.ejca.2013.04.024","article-title":"Worldwide trends in cervical cancer incidence: Impact of screening against changes in disease risk factors","volume":"49","author":"Vaccarella","year":"2013","journal-title":"Eur J Cancer"},{"key":"2021122510445082600_onco13339-bib-0003","author":"Fertility statistics"},{"key":"2021122510445082600_onco13339-bib-0004","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1002\/ijgo.12749","article-title":"Revised FIGO staging for carcinoma of the cervix uteri","volume":"145","author":"Bhatla","year":"2019","journal-title":"Int J Gynaecol Obstet"},{"key":"2021122510445082600_onco13339-bib-0005","doi-asserted-by":"crossref","first-page":"1293","DOI":"10.1097\/IGC.0000000000000763","article-title":"Vaginal radical trachelectomy for early-stage cervical cancer: Increased recurrence risk for adenocarcinoma","volume":"26","author":"Zusterzeel","year":"2016","journal-title":"Int J Gynecol Cancer"},{"key":"2021122510445082600_onco13339-bib-0006","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1016\/j.ygyno.2010.12.345","article-title":"The vaginal radical trachelectomy: An update of a series of 125 cases and 106 pregnancies","volume":"121","author":"Plante","year":"2011","journal-title":"Gynecol Oncol"},{"key":"2021122510445082600_onco13339-bib-0007","doi-asserted-by":"crossref","first-page":"982","DOI":"10.1097\/IGC.0b013e318295906b","article-title":"Evolution in fertility-preserving options for early-stage cervical cancer: Radical trachelectomy, simple trachelectomy, neoadjuvant chemotherapy","volume":"23","author":"Plante","year":"2013","journal-title":"Int J Gynecol Cancer"},{"key":"2021122510445082600_onco13339-bib-0008","doi-asserted-by":"crossref","first-page":"e240","DOI":"10.1016\/S1470-2045(16)30032-8","article-title":"Oncological outcomes after fertility-sparing surgery for cervical cancer: A systematic review","volume":"17","author":"Bentivegna","year":"2016","journal-title":"Lancet Oncol"},{"key":"2021122510445082600_onco13339-bib-0009","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1016\/j.ygyno.2014.08.021","article-title":"Oncological and pregnancy outcomes after high-dose density neoadjuvant chemotherapy and fertility-sparing surgery in cervical cancer","volume":"135","author":"Robova","year":"2014","journal-title":"Gynecol Oncol"},{"key":"2021122510445082600_onco13339-bib-0010","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1016\/j.ygyno.2019.09.025","article-title":"Abdominal radical trachelectomy versus chemotherapy followed by vaginal radical trachelectomy in stage 1B2 (FIGO 2018) cervical cancer. 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