Neoadjuvant Paclitaxel-Carboplatin Chemotherapy Followed by Cesarean Radical Hysterectomy in Pregnant Patients With Cervical Cancer: Obstetric, Neonatal, and Surgical Outcomes.
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OBJECTIVE: To evaluate pregnancy, peripartum, neonatal, and oncologic outcomes in pregnant patients with cervical cancer treated with neoadjuvant paclitaxel-carboplatin chemotherapy followed by cesarean radical hysterectomy (CRH). METHODS: This retrospective single-center study included nine pregnant women diagnosed with histologically confirmed cervical cancer during pregnancy who received neoadjuvant chemotherapy and subsequently underwent CRH between 2011 and 2023. Maternal clinical characteristics, chemotherapy-related toxicities, surgical outcomes, placental pathology, and neonatal outcomes were reviewed. Disease-free survival and overall survival were descriptively assessed. RESULTS: The median gestational age at diagnosis was 14.1 weeks (range, 4.2-28.1 weeks). All patients received paclitaxel-carboplatin chemotherapy after the first trimester (median, three cycles). The median gestational age at CRH was 33.5 weeks (range, 30.6-36.3 weeks). Median estimated blood loss was 1800 mL, and most patients required perioperative transfusion. Placental examination frequently demonstrated maternal underperfusion. One infant was small for gestational age, and most neonates were admitted to the NICU for prematurity-related monitoring; all complications resolved without long-term sequelae. During a median follow-up of 62 months, no recurrence or death was observed. CONCLUSION: Neoadjuvant paclitaxel-carboplatin chemotherapy followed by CRH allowed continuation of pregnancy until delivery in this small cohort of patients with cervical cancer during pregnancy. Despite frequent NICU admission, prematurity-related complications, and substantial surgical morbidity, neonatal complications were mostly transient and long-term oncologic outcomes appeared reassuring. These findings support the feasibility of this multidisciplinary treatment approach in carefully selected patients who wish to continue their pregnancy.