Chemo-conization in Early-sTage cERvical caNcer >2 cm scheduled for fertilItY-sparing approach: an analysis of the ETERNITY project.

To investigate the safety of neoadjuvant chemotherapy and conization in early-stage cervical cancer with a tumor size >2 cm using a fertility-sparing approach. The ETERNITY project is a retrospective, multi-institutional study that collected data from patients with early-stage cervical cancer undergoing fertility-sparing treatment. In the present study, we report the outcomes of stage IB2 to IB3 cervical cancer undergoing nodal assessment, neoadjuvant chemotherapy, and conization. A propensity-matching algorithm was used to compare patients who underwent upfront radical surgery. A total of 395 patients were included in the ETERNITY project. Among these, 25 underwent a fertility-sparing attempt with nodal assessment, neoadjuvant chemotherapy, and conization. The median (range) patient age was 37 (24-41) years. Four (16%) patients with positive nodes required definitive chemo-radiation. Twenty-one (84%) patients received neoadjuvant chemotherapy. Two (8%) patients with stable disease underwent radical hysterectomy, whereas the remaining 19 (76%) patients who achieved a clinical response underwent cervical conization. Three (12%) patients underwent radical hysterectomy owing to persistent positive margins, leaving 16 (64%) patients who completed the planned fertility-sparing attempt. After a median (range) follow-up of 36.2 (21.9-88) months, 3 recurrences occurred. Two patients with cervical recurrence underwent hysterectomy, while 1 patient who received definitive chemoradiotherapy owing to the presence of positive nodes developed distant recurrence. Regarding obstetric outcomes, 6 patients attempted to conceive, and 4 (66.7%) pregnancies were achieved (1 was achieved with assisted reproductive technology). In a propensity-matched group of patients who underwent upfront radical surgery, no differences in morbidity or survival rates were recorded. Neoadjuvant chemotherapy followed by conization should be investigated in selected patients with cervical cancer who wish to preserve their childbearing potential. Further prospective studies are needed to assess the long-term safety and identify predictors of response. NCT06351228.