Neoadjuvant chemotherapy plus radical surgery followed by chemotherapy in locally advanced cervical cancer

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Abstracts / Gynecologic Oncology 125 (2012) S3–S167

Conclusions: The addition of TPZ to CIS chemo-radiation did not improve PFS or OS, although definitive commentary was limited by an inadequate number of events (progression or death). TPZ/CIS chemo-radiation was tolerable at a modified starting dose. Further evaluation of other combination therapies with radiation in locally advanced cervix cancer is warranted. doi:10.1016/j.ygyno.2011.12.003

3 Neoadjuvant chemotherapy plus radical surgery followed by chemotherapy in locally advanced cervical cancer R. Angioli1, D. Luvero1, F. Plotti1, M. Zullo1, P. Damiani1, M. Angelucci1, R. Ricciardi1, A. Aloisi1, G. Scaletta1, P. Benedetti Panici2. 1Campus BioMedico of Rome, Rome, Italy, 2La Sapienza, University of Rome, Rome, Italy. Objective: The aim of this study is to evaluate the efficacy, in terms of overall survival (OS) and progression-free survival, and safety of adjuvant chemotherapy after neoadjuvant chemotherapy followed by radical surgery both in patients with and without node metastases. Methods: Between June 2000 and May 2007, all patients with diagnoses of locally advanced cervical cancer referred to the Division of Gynecologic Oncology of the University Campus Bio-Medico of Rome were eligible for this protocol. All enrolled patients received 3 cycles of platinumbased chemotherapy every 3 weeks according to the scheme Cisplatin 100 mg/mq and Paclitaxel 175 mg/mq. After neoadjuvant chemotherapy, all patients with stable disease were excluded from the protocol. All other patients underwent classical radical hysterectomy and bilateral systematic pelvic lymph node dissection, followed by adjuvant treatment with 6 cycles of platinum based chemotherapy with Cisplatin 100 mg/mq and Paclitaxel 175 mg/mq. Results: In this study, 110 patients with local advanced cervical cancer received the treatment with neoadjuvant chemotherapy followed by radical surgery and adjuvant chemotherapy. Our study focused on clinical and operative data, in terms of OS and disease-free survival at 5 and 3 years. Five-year OS of our series was 78% and 86% at 3-years, with encouraging results also in subgroup with and without node mestastases. Conclusions: The adjuvant chemotherapy regimen after neoadjuvant chemotherapy and radical surgery represents a valid treatment option for patients with locally advanced cervical cancer without lymph node involvement, both in terms of OS and disease-free interval. The results have also confirmed the validity of this approach in lymph node metastases, with a complication rate lower than the standard radio-chemotherapy regime.

resection, frequently preserving the main uterine vasculature. Questions arise as to whether fertility is maintained following the abdominal approach, particularly when the uterine vessels are sacrificed. We report on an international series on RAT to describe fertility and oncologic outcomes. Methods: Clinical databases at 3 institutions were queried to identify patients (pts) planned for RAT (1999–2011). All procedures were performed in a standard fashion consistent with a type C resection with ligation of both uterine arteries at their origin from the hypogastric. Clinical and demographic data were gathered from the medical record. Results: In all, 101 pts underwent RAT. Mean age was 31 years (range, 19– 43), and 84 (83%) were nulliparous. Eighty-four were stage IB1 (83%). Histology was: adenocarcinoma (n =54), squamous (n =40), adenosquamous (n =6), and clear cell (n=1). A median of 24 lymph nodes (range, 2–60) were removed. Twenty pts (20%) required immediate completion hysterectomy (10 margins, 10 nodes). Eight pts returned to completion hysterectomy due to positive margins on final pathology (n=3), pts' choice (n=4), and recurrence (n=1). Postoperatively, 20 pts (20%) received adjuvant chemotherapy and/or radiation (4 margins on final pathology, 16 nodes). Four patients recurred (4%), currently living 22–35 months from diagnosis. Of the 70 women who maintained fertility (no hysterectomy or adjuvant therapy), a total of 38 (54%) have attempted pregnancy, and 28/38 (74%) achieved pregnancy. A total of 31 pregnancies led to 16, 3rd trimester deliveries (52%), and 6 additional pts are currently pregnant with outcomes pending. Conclusions: These data dispel the myth that fertility is compromised following abdominal trachelectomy and validate the fertility-preserving potential of RAT while maintaining excellent oncologic outcomes. The majority (74%) of women attempting pregnancy after RAT are able to achieve pregnancy and deliver in the third trimester. Preservation of the uterine vasculature is not necessary for fertility, and obstetrical outcomes are similar to those of the historical RVT cohorts.

doi:10.1016/j.ygyno.2011.12.004

Education Forum: II Oncofertility: Preserving Fertility for Patients with GYN Cancers Saturday, March, 24, 2012, 4:00 p.m.–5:15 p.m. Ballroom E,F,G (Austin Convention Center) Moderator, Abstracts: 4–6: Linda Van Le, MD, University of North Carolina School of Medicine, Chapel Hill, NC 4 An international series on abdominal trachelectomy: 101 patients and 28 pregnancies S. Wethington1, D. Cibula2, L. Duska3, L. Garrett4, C. Kim1, Y. Sonoda1, N. AbuRustum1. 1Memorial Sloan-Kettering Cancer Center, New York, NY, 2Charles University, Czech Republic, 3University of Virginia Health System, Charlottesville, VA, 4Massachusetts General Hospital/Harvard University, Boston, MA. Objective: Radical abdominal trachelectomy (RAT) is a type C resection with the uterine vessels ligated at their origin from the hypogastric, whereas a radical vaginal trachelectomy (RVT) is more consistent with a type B

doi:10.1016/j.ygyno.2011.12.005