Ovarian preservation in locally advanced cervical cancer undergoing neoadjuvant chemotherapy and radical surgery

BACKGROUND: The aim of this study was to estimate the rate of ovarian metastases and recurrences among patients affected by locally advanced stage cancer patients (LACC), undergoing neoadjuvant chemotherapy (NACT) and radical surgery with conservation of ovaries. METHODS: Retrospective evaluation of consecutive patients affected by LACC (stage IB2-IIB), treated by NACT followed by radical surgery at National Cancer Institute, Milan, Italy, between 1990-2015. RESULTS: Overall, 331 patients were included. Stage at presentation included stage IB2, IIA and IIB in 120 (36.3%), 63 (19%) and 148 (44.7%) patients, respectively. Main histotype was squamous cell carcinoma (N.=265, 80.1%) followed by adenocarcinoma/adenosquamous (N.=51, 15.4%), and more than half of patients had a grade 3 carcinoma. Overall, 102 (30.8%) women had at least one ovary preserved during surgery, while 229 (69.2%) had bilateral salpingo-oophorectomy. Comparing patients who had ovarian preservation with patients who had not, we observed that the two groups were comparable in terms of baseline characteristics. Survival outcomes were not influenced by ovarian preservation (disease-free [P=0.93] and overall [P=0.65] survivals). One (1%) woman had a localized ovarian recurrence. CONCLUSIONS: Our data suggest that ovarian preservation at the time of surgery is a safe option among women with LACC after NACT with no detrimental impact on oncologic outcome. Further prospective studies are warranted.