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Analysis of a continuous series of 34 young patients with early-stage cervical cancer selected for a vaginal radical trachelectomy: should "staging" conization be systematically performed before this procedure?
MedLine Citation:
PMID:  23358180     Owner:  NLM     Status:  In-Data-Review    
OBJECTIVE: Vaginal radical trachelectomy (VRT) is the most widely evaluated form of conservative management of young patients with early-stage (IB1) cervical cancer. Patients with nodal involvement or a tumor size greater than 2 cm are not eligible for such treatment. The aim of this study is to report the impact of a "staging" conization before VRT.
METHODS: This is a retrospective study of 34 patients potentially selected for VRT for a clinical and radiologic cervical tumor less than 2 cm. Among them, 28 underwent finally a VRT (20 of them having a previous conization before this procedure) and 6 patients with macroscopic cervical cancer, confirmed by punch biopsies, "eligible" for VRT (<2 cm) had undergone "staging" conization (without further VRT) to confirm the tumor size and lymphovascular space involvement (LVSI) status.
RESULTS: Six patients having "staging" conization before VRT had finally been deemed contraindications to VRT due to the presence of a histologically confirmed tumor greater than 2 cm and/or associated with multiple foci of LVSI. Among 28 patients who underwent VRT, 1 received adjuvant chemoradiation (this patient recurred and died of disease). Two patients treated with RVT (without postoperative treatment) recurred. Ten pregnancies (9 spontaneous and 1 induced) were observed in 9 patients. Among 4 patients with macroscopic "visible" tumor who do not underwent a "staging" conization before VRT, 2 recurred. Among 11 patients who underwent VRT and having LVSI, 3 recurred.
CONCLUSIONS: These results suggest that if a conization is not performed initially, it should then be included among the staging procedures to select patients for VRT.
Catherine Uzan; Sebastien Gouy; Delphine Desroque; Christophe Pomel; Pierre Duvillard; Corrine Balleyguier; Christine Haie-Meder; Philippe Morice
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  International journal of gynecological cancer : official journal of the International Gynecological Cancer Society     Volume:  23     ISSN:  1525-1438     ISO Abbreviation:  Int. J. Gynecol. Cancer     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-01-29     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9111626     Medline TA:  Int J Gynecol Cancer     Country:  United States    
Other Details:
Languages:  eng     Pagination:  331-6     Citation Subset:  IM    
*Department of Gynecologic Surgery, †Unit INSERM U 10-30, Institut Gustave Roussy, Villejuif; ‡Department of Surgery, Centre Jean Perrin, Clermont-Ferrand; Departments of §Pathology, ∥Imaging, ¶Radiation Oncology, Institut Gustave Roussy, Villejuif; and #Université Paris-Sud (Paris XI), Le Kremlin Bicêtre, France.
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