Effect of treatment choices for cervical adenocarcinoma in situ on rates of residual disease, recurrence and progression
Keywords: cervix uterineoplasm, hysterectomy conisation, neoplasm recurrence, local
AbstractBackground: Cervical adenocarcinoma in situ (AIS) is the known precursor condition of cervical adenocarcinoma. The aim of this study is to evaluate treatment choices for AIS in terms of residual disease, recurrence and progression to invasive cancer. Methods: This is a retrospective cohort study conducted at the Mercy Hospital for Women in Melbourne, Australia. Women diagnosed with AIS on histology between 2000 and 2013 were included. Patient records were reviewed for notes on symptoms, cytology, colposcopy and biopsy reports, initial treatment, any subsequent treatment, outcome and follow-up. Results: A total of 114 patients were included: 87 patients were treated with one or more fertility-sparing procedures; 25 patients received a subsequent hysterectomy, one a trachelectomy and one chemo- and radiotherapy. Residual disease was found in 31% (9/29) after a previous procedure with positive margins. In 13.3% (2/15) residual disease was diagnosed despite clear surgical margins. The mean follow-up time was 78.6 months (range 7.9–183). Two patients (2/87, 2.3%) who primarily received fertility-sparing treatment had recurrent AIS. None of the patients progressed to invasive cancer. Conclusion: Both positive and negative margins after initial treatment must be carefully considered in each case. With negative margins, fertility-sparing surgery should be a treatment choice available for all women, not only for those who want to preserve fertility. Fertility-sparing surgery requires regular follow-up. (Full text available online at www.medpharm.tandfonline.com/ojgo) South Afr J Gynaecol Oncol 2017; DOI: 10.1080/20742835.2017.1402434
By submitting manuscripts to SAJGO, authors of original articles are assigning copyright to the South African Society of Gynaecologic Oncology (SASGO). Authors may use their own work after publication without written permission, provided they acknowledge the original source. Individuals and academic institutions may freely copy and distribute articles published in SAJGO for educational and research purposes without obtaining permission.