Prospective management of stage IA(1) cervical adenocarcinoma by conization alone to preserve fertility: A preliminary report

Objective. Microinvasive cervical adenocarcinoma has an excellent prognosis and emerging data support the hypothesis that it should be treated in the same way as its squamous counterpart. We report our preliminary experience prospectively treating stage IA(1) cervical adenocarcinoma by conization al one in women who strongly desired to preserve their fertility. Methods. Since May 1998, all patients with stage IA(1) cervical adenocarcin oma who expressed a strong desire to preserve fertility have been offered c old knife conization (CKC) and careful surveillance without hysterectomy. W omen with lesions identifiable only microscopically, up to 3 mm invasive de pth, up to 7 mm tumor width, and a conization specimen including the entire lesion with negative margins were eligible for conservative management. Po stconization surveillance consisted of a Pap smear and endocervical curetta ge every 4 months. Medical records were reviewed for clinical data, follow- up, and disease status. Results. Five women ages 26-33 elected CKC and surveillance. Four were null iparous and one primiparous. Four tumors were endocervical cell type; one w as adenosquamous, Three were grade 1, one was grade 2, and one grade 3, Non e had lymph-vascular space invasion. None of the patients has developed rec urrent disease after 6-20 months of follow-up. Conclusions, Our preliminary data suggest that patients with FIGO stage IA( 1) cervical adenocarcinoma who strongly desire to preserve their fertility may be treated by conization alone if they are fully informed of the unknow n risks for disease recurrence and are carefully followed. A multicenter tr ial is the next logical step to test the efficacy of this approach. (C) 200 0 Academic Press.