Neoadjuvant chemotherapy followed by fertility-sparing surgery for women with stage IB1 cervical cancer
A 31-year-old G1P0 was admitted to hospital for intermenstrual bleeding for 5 months. The gynecologic physical examination revealed a tumor measuring 3.5 cm×3.5 cm, and the biopsy showed invasive squamous cell carcinoma (moderate-low differentiation). She was given one cycle chemotherapy (PB regimen: bleomycin 15 mg/m2, day 1; cisplatin 25 mg/m2, day 1-3) on November 12nd-14th 2003. The side effect was fever (grade 1). The repeat gynecologic physical examination showed that the tumor had shrunk to 2 cm, and the doctor suggested she underwent a radical hysterectomy. But she wanted to reserve her fertility and refused the surgery. We told her that the possibility of recurrence and she signed the consent. On December 15th 2003, she underwent the surgery. First she underwent pelvic lymphadenectomy and the frozen sections of lymph nodes were negative. Then she underwent VRT. The final histopathology confirmed a squamous cell carcinoma (moderate differentiation, 6 mm in depth, 12 mm in width, which involved more than half of the cervical stroma). The final histology of 8 lymph nodes was negative. After surgery, she was given three cycles of adjuvant chemotherapy using the same regimen of bleomycin and cisplatin. The side effect was vomiting (grade 2) which was tolerable. She was followed up via gynecologic physical examination, colposcopy every month in the first 6 months and positron-emission tomography each year. The Thinprep cytologic test (TCT) and serum level of squamous cell carcinoma (SCC) was normal. The patient did not desire pregnancy at the time of this writing.