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CC BY 4.0 · Rev Bras Ginecol Obstet 2023; 45(04): 201-206
DOI: 10.1055/s-0043-1769000
Original Article
Oncology

Conservative Treatment of Stage IA1 Cervical Carcinoma Without Lymphovascular Space Invasion: A 20-year Retrospective Study in Brazil

Tratamento conservador do câncer do colo do útero IA1 sem invasão linfovascular: estudo retrospectivo no Brasil
Daniele Lima Alberton 
1   Obstetrics and Gynecology Department, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil
2   Obstetrics and Gynecology Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
,
Mila Pontremoli Salcedo 
1   Obstetrics and Gynecology Department, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil
3   Department of Gynaecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
,
Raquel Potrich Zen 
4   Internal Medicine, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Brazil
,
Charles Francisco Ferreira 
5   Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
,
Kathleen Schmeler 
3   Department of Gynaecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States
,
Suzana Arenhart Pessini 
2   Obstetrics and Gynecology Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
5   Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Abstract

Purpose: To evaluate recurrence rates and risk factors among women with stage IA1 cervical cancer without lymph vascular space invasion managed conservatively.

Methods: retrospective review of women with stage IA1 squamous cervical cancer who underwent cold knife cone or loop electrosurgical excision procedure, between 1994 and 2015, at a gynecologic oncology center in Southern Brazil. Age at diagnosis, pre-conization findings, conization method, margin status, residual disease, recurrence and survival rates were collected and analyzed.

Results: 26 women diagnosed with stage IA1 squamous cervical cancer without lymphovascular space invasion underwent conservative management and had at least 12 months follow-up. The mean follow-up was 44.6 months. The mean age at diagnosis was 40.9 years. Median first intercourse occurred at age 16 years, 11.5% were nulliparous and 30.8% were current or past tobacco smokers. There was one Human immunodeficiency virus positive patient diagnosed with cervical intraepithelial neoplasia grade 2 at 30 months after surgery. However, there were no patients diagnosed with recurrent invasive cervical cancer and there were no deaths due to cervical cancer or other causes in the cohort.

Conclusion: Excellent outcomes were noted in women with stage IA1 cervical cancer without lymphovascular space invasion and with negative margins who were managed conservatively, even in a developing country.

Resumo

Objetivo: Avaliar recidiva e seus fatores de risco em mulheres com câncer do colo do útero estádio IA1 sem invasão do espaço linfovascular tratadas conservadoramente.

Métodos: Estudo de coorte retrospectivo de pacientes com câncer do colo do útero IA1 escamoso submetidas a cone do colo do útero, entre 1994 e 2015, em um centro de ginecologia oncológica do sul do Brasil. Foram revisados e analisados idade no diagnóstico, achados pré-conização, método de conização, margens, doença residual, recorrência e sobrevida.

Resultados: 26 mulheres diagnosticadas com câncer do colo do útero estádio escamoso sem invasão do espaço linfovascular foram submetidas a tratamento conservador, com seguimento mínimo de 12 meses. O tempo médio de seguimento foi 44,6 meses. A média de idade no diagnóstico foi 40,9 anos. A primeira relação sexual ocorreu aos 16 anos (mediana), 11,5% eram nulíparas e 30,8% eram tabagistas atuais ou passadas. Houve um caso de recidiva de neoplasia intraepitelial cervical grau 2 aos 30 meses em uma paciente com vírus da imunodeficiência humana. Não houve pacientes diagnosticados com câncer de colo do útero invasor recorrente, e não houve mortes por câncer do colo do útero ou outras causas.

Conclusão: Os resultados observados após tratamento conservador em mulheres com câncer cervical escamoso IA1 sem invasão do espaço linfovascular com margens negativas foram excelentes, mesmo em um país em desenvolvimento.

Keywords

Uterine cervical neoplasms - Conization - Conservative treatment - Recurrence - Squamous cell carcinoma

Palavras-chave

Neoplasias do colo do útero - Conização - Tratamento conservador - Recorrência - Carcinoma de células escamosas

Contributions

Authors D.L.A., S.A.P. and M.P.S. conducted all aspects of conception, design and provision of study materials or patients. Authors D.L.A. and R.P.Z. conducted collection and assembly data. D.L.A., C.F.F., S.A.P. and M.P.S. conducted analysis and interpretation. D.L.A. wrote the manuscript with input from all other authors. Authors S.A.P., M.P.S. and K.M.S. collaborated with the critical revision of the article. All authors approved the final manuscript.




Publication History

Received: 06 August 2022

Accepted: 22 November 2022

Article published online:
24 May 2023

© 2023. Federação Brasileira de Ginecologia e Obstetrícia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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