Thirty-years experience of organsaving treatment in oncological gynecology

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The aim. To analyzed one of the aspect of the medical-social rehabilitation of the patients after organ-saving treatment of gynecological neoplasms.

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Methods and material. We have analyzed comprehensive clinical data of 971 women of reproductive age with early gynecological cancer who were treated in the Department of Oncogynecology of P.A.Hertsen Moscow Oncological Institute in 1975 - 2004. The first group included 688 women with precancerous lesions and early cervical cancer (severe cervical dysplasia - 90 (13,1%), cervical cancer in situ - 342 (49,7%), cervical cancer stage Ial - 246 (35,6%), cervical cancer stage Ia2 - 4 (0,6%). The mean age of patients was 33,6 ± 1,2 y.o. The second group included 158 patients with malignant ovarian tumors: non-epithelial tumors - 99 (62,7%), borderline tumors - 35 (22,1%) and ovarian cancer - 24 (15,2%). The mean age of patients was 24,9 ± 0,9 y.o. The third group comprised 125 patients with either atypical endometrial hyperplasia - 57 (45,6%) or early endometrial cancer - 68 (54,4%). The mean age of patients was 21,5 ± 1,1 y.o. The follow-up period was 6 month - 29 years.

Results. Post-treatment fertility rates were relatively high in all groups: group 1 - 19,8% (208 pregnancies for 136 women), group 2 - 48,7% (151 pregnancies for 77 women), group 3 - 23,2% (40 pregnancies for 29 women). However, the number of interrupted pregnancies was quite high: group 1-110 (52,9%), group 2 - 59 (39,1%), group 3-7 (20%). Only a few pregnancies occurred within a short time interval after the completion of treatment and were therefore interrupted. Spontaneous abortions occurred in 51 patients: in group 1-31 (14,9%), 2 - 11 (7,3%) and in 3 - 9 (25,7%) cases. There were 3 (1,4%) cases of ectopic pregnancy in group 1. We observed 4 (1,9%) cases in 1 group and 1(0,6%) in 3 group cases of non-developing pregnancy. At present 12 women are pregnant: 5 - in the 1st group (2,4%), 2 (1,3%) - in the 2nd group and 5 (12,5%) - in the 3d group. The number of pregnancies resulted in childbirth was as follows: conservative treatment of cervical lesions - 56 (26,9%) pregnancies, unilateral tubo-ovariectomy - 78 (47,5%), endometrial pre-cancer and cancer - 19 (47,5%). On-term babies are alive and develop normally. An important issue is obviously the impact of pregnancy on the outcome of oncological disease. We observed 4 (2,9%) relapses in patients of the 1st group, 10 (12,9%) cases - in group 2, 2 (8%) in group 3. These results are comparable to recurrence rates of patients who underwent conservative treatment and had no pregnancies.

Conclusion. To sum it up, adequate conservative treatment of early gynecological malignancies provides long-term recovery and allows for normal female functioning, which is essential for medical and social rehabilitation of women.