Fertility Preservation Practices in Cervical Cancer in Asia: ASGO Special Task Force on Fertility Preservation Survey

Abstract

<p><strong>Introduction</strong></p><p>In the management of cervical cancer, fertility preservation (FP) among women of reproductive age has gained increasing attention. Whilst achieving a curative treatment is paramount, conserving fertility potential should be integrated in the treatment plan. Although there have been numerous advances in the fertility-sparing surgery (FSS) and reproductive technologies over the years, clinical practice differs across regions. The Asian Society of Gynecologic Oncology (ASGO) Special Task Force on Fertility Preservation (STF-FT) has been active in advocating FP options across Asia. </p><p><br></p><p><strong>Objective</strong></p><p>This survey which is a collaborative effort among gynecologic oncologists and reproductive endocrinologists aimed to evaluate these practices and ultimately improve fertility outcomes among adolescent and young adult (AYA). </p><p><br></p><p><strong>Methods</strong></p><p>A questionnaire survey was conducted in 10 Asian regions (China, Hong Kong, India, Indonesia, Japan, Malaysia, Philippines, South Korea, Taiwan, Thailand) to evaluate the indications and practices of FP treatments for cervical cancer. The responses were collected by representative institution or clinicians reporting the practices in each region. </p><p><br></p><p><strong>Results</strong></p><p>Although some regions have cancer registry, most do not have information on patients receiving FP treatment. FSS including conization and trachelectomy are available for cervical cancer stage IA to IB1 mostly in women aged <40 years. Both pelvic lymph node dissection or sentinel node biopsy are acceptable with conization or trachelectomy. Conization using loop electrosurgical procedure or cold knife is an option for stage IA1 or IA2 without lymphovascular invasion or adenocarcinoma in-situ. Trachelectomy is available in most regions and is indicated in stage IA to IB1. Abdominal or vaginal trachelectomy is performed in most regions while laparoscopic or robotic route is available in a few regions. Most regions perform cervical cerclage during trachelectomy, while some perform it during pregnancy. The indication of adjuvant treatment including completion hysterectomy and chemoradiation is the same as standard practice for non-FP patients. Follow-up practices vary across regions with some performing MRI, USS for cervical length during pregnancy and colposcopy. Generally, pregnancy is allowed after 6 months (range 6-24 months) of conization or trachelectomy. Ovarian transposition is performed during radical trachelectomy or hysterectomy or before radiotherapy in selected centers. Uterine transplantation is not available in most regions.</p><p><br></p><p><strong>Conclusion</strong></p><p>Owing to the differences of practice across the regions, a standardized guideline to inform on the FP management in cervical cancer in Asia is required. Collaboration within ASGO in producing and disseminating this guideline will help to enhance the fertility outcomes among AYA women across the region. </p>