Table 1 Fertility-sparing interventions in women with cervical or endometrial cancer
From: Fertility preservation in women with cervical, endometrial or ovarian cancers
Diagnosis | Type of Surgery | Description | Reproductive and Obstetric Outcomes | Oncologic Outcome | Quality of Life |
|---|---|---|---|---|---|
Cervical Cancer FIGO Stage IA1 (microinvasion <3Â mm) | Large loop excision of the transformation zone (LLETZ) or conization if absence of lymph vascular space invasion and negative margins are confirmed | Complete resection of the transformation zone | No fertility impairment reported. OR 1.7 for preterm delivery and 2.69 for premature rupture of membranes; associated with resection size. No difference in neonatal outcome [130] | Similar oncologic outcomes reported in comparison with hysterectomy [10] | Conization has not been associated with reduced quality of life or sexual satisfaction [49] |
FIGO Stages IA2, IB1 < 2 cm | Cervical conization and laparoscopic lymphadenectomy | Conization of the cervix and laparoscopic pelvic lymphadenectomy | Spontaneous conceptions of about 47 %. Prematurity rates reported with 14.3 % of infants born <32 weeks of gestation [21] | Excellent rates of 5-year disease-free survival (97 %) [21] | Conization with laparoscopic lymphadenectomy has not been associated with reduced quality of life or sexual satisfaction [49] |
FIGO Stages IA2, IB1 | Radical trachelectomy. Techniques described for vaginal, abdominal, laparoscopic or robotic trachelectomy | Resection of the cervix and surrounding parametria with conservation of the uterus and the ovaries, pelvic lymphadenectomy | Spontaneous pregnancy rates in >60 % of patients Preterm deliveries with 28 % of infants born <32 weeks of gestation [17, 132] | Rates of recurrence and mortality are comparable with those described for similar cases treated with radical hysterectomy; long-term survival 98.4 %. Low relapse rates (4.5 %) [16, 17] | Lower quality of life than healthy controls but similar to radical hysterectomy No significant impairment in sexual satisfaction Long-term bladder complications (40 %) and lymphedema (10 %) [46–48] |
FIGO Stage IB1, >2Â cm | Neoadjuvant chemotherapy followed by radical trachelectomy | Three cycles of paclitaxel, cisplatin and ifosfamide followed by radical trachelectomy | After neoadjuvant chemotherapy and trachelectomy up to 86Â % live-birth rates with 86Â % spontaneous conception rate [134] | Reported relapse rate of 7.6Â % with 90Â % survival [23, 24] | Lack of data |
Endometrial Cancer FIGO stage IA | Medical conservative treatment with hormone therapy using progestational agents either orally or by IUD for >6 months Myometrial evaluation by MRI should be performed to confirm absence of myometrial infiltration and no extrauterine involvement [52]. | Follow-up by hysteroscopic exams with endometrial biopsies every 3 months | Pregnancy rates of >60 % | Positive response rate to progesterone treatment of 72 %. Either oral or local IUD treatments proposed, as well as a combination of both. Relapse rate of 50 %. A second round of progesterone therapy in cases of relapse has been associated with a response rate of up 89 % [55, 57, 60, 62]. A levonorgestrel IUD has shown greater regression on histology, lower relapse rates and lower rates of hysterectomy for treatment of complex endometrial hyperplasia vs. oral progesterone [57–59]. | Levonorgestrel IUD treatment has been associated with fewer systemic side effects compared with oral progesterone administration [79, 80] |