Chemotherapy for cervical cancer and contraception: discussion issues and clinical case

Cervical cancer occupies one of the leading places in the structure of oncological diseases of the Female Reproductive System. In the treatment of this pathology, along with the surgical method of treatment, chemotherapy and radiation therapy are used. According to clinical guidelines, in the presence of cervical cancer stages IIB–IIIA, it is allowed to carry out 2–4 cycles of neoadjuvant chemotherapy in order to create conditions for the possibility of performing extended hysterectomy according to Meigs. Pregnancy during chemotherapy is unique and extremely rare.
The article presents a clinical case of pregnancy during chemotherapy (performed according to the scheme: taxanes and platinum-containing drugs) in a 27-year-old patient. According to the clinical picture and results of cervical biopsy, the diagnosis was made: invasive nonkeratinizing squamous cell carcinoma of the cervix IIB (cT2bNxM0) G2, right-sided parametric variant, nonspecific (with unspecified HPV status). Taking into account the presence of parametrial infiltration, the age of the patient, the oncological council prescribed from 2 to 4 cycles of chemotherapy according to the TC scheme (paclitaxel, carboplatin) with an interval assessment. After the second cycle of chemotherapy, an early pregnancy was diagnosed – a medical abortion was performed. Against the background of 3 cycles of chemotherapy, the conditions for surgical treatment were formed – surgical treatment was performed in the amount of extended hysterectomy according to Meigs (type III according to Piver/C2 Morrow) with transposition of the ovaries. The postoperative period was uneventful; the patient was discharged in a satisfactory condition.
The described case of pregnancy on the background of chemotherapy is of scientific and practical interest, initiating a discussion on the need to counsel such patients regarding reliable contraception, taking into account the eligibility criteria, which will avoid undesirable outcomes during cancer treatment.

1. Sung H., Ferlay J., Siegel R.L. et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021;71:209–49. DOI: 10.3322/caac.21660

2. The stаte of oncologicаl cаre to the populаtion of Russiа in 2021. Ed. by А.D. Kаprin, V.V. Stаrinskiy, А.O. Shаkhzаdovа. Moscow: P. Hertzen Moscow Oncology Research Institute – branch of the National Medical Research Radiology Center, Ministry of Health of Russia, 2022. 239 p. (In Russ.).

3. WHO Classification of Tumours. Female Genital Tumours. 5th edn. Lyon: IARC, 2020. DOI: 10.1055/a-1545-4279

4. Schmidt A.A., Alieva M.T., Zakharov I.S. Predicting the risk of development and progression of diseases associated with the human papillomavirus in female military personnel. Voenno-meditsinskiy zhurnal = Military Medical Journal 2023;7:52–5. (In Russ.).

5. Еlgina S.I., Zolotorevskaya O.S., Zakharov I.S. et al. Cytological screening for cervical cancer diagnosing. Mat i ditya v Kuzbasse = Mother and Baby in Kuzbass 2019;78(3):37–40. (In Russ.).

6. Bhatla N., Aoki D., Sharma D.N., Sankaranarayanan R. Cancer of the uteri. FIGO Cancer Rep 2018;142:22–36. DOI: 10.1002/ijgo.12611

7. Khokhlova S.V., Kolomiets L.A., Kravets O.A. et al. Practical guidelines for drug treatment of cervical cancer. Zlokachestvennye opukholi: Prakticheskie rekomendatsii RUSSCO = Malignant Tumors: RUSSCO Practice Guidelines 2021;11(3s2):197–217. (In Russ.). DOI: 10.18027/2224-5057-2021-11-3s2-13

8. Clinical recommendations “Cervical cancer”. Ministry of Health of Russia. Moscow, 2020. 48 p. (In Russ.).

9. Sedlis A., Bundy B.N., Rotman M.Z. A randomized trial of pelvic radiation therapy versus no further therapy in selected patients with stage IB carcinoma of the cervix after radical hysterectomy and pelvic lymphadenectomy: a Gynecologic Oncology Group Study. Gynecol Oncol 1999;73(2):177–83. DOI: 10.1006/gyno.1999.5387

10. Vartanyan A.A., Ogorodnikova M.V. Molecular mechanisms of action of platinum preparations. Rossiyskiy bioterapevticheskiy zhurnal = Russian Biotherapeutic Journal 2004;(1):14–9. (In Russ.).

11. Hoskins W.J. Principles and Practice of Gynecologic Oncology. Philadelphia: Lippincott Williams & Wilkins, 2005. 1419 p.

12. Boyat I., Oganesyan E.A., Balabanan V.Yu., Alyautdin R.N. Medicinal forms of paclitaxel. Rossiyskiy bioterapevticheskiy zhurnal = Russian Biotherapeutic Journal 2009;8(3):37–44. (In Russ.).

13. Goldberg E.D., Borovskaya T.G. Long-term effects of the toxic effect of cytostatic drugs on the reproductive system. Sibirskiy nauchnyy meditsinskiy zhurnal = Siberian Scientific Medical Journal 2004;(2):32–6. (In Russ.).

14. Salama M., Woodruff T.K. Anticancer treatments and female fertility: clinical concerns and role of oncologists in oncofertility practice. Expert Rev Anticancer Ther 2017;17(8):687–92. DOI: 10.1080/14737140.2017.1335199

15. Vartanyan E.V., Dobrokhotova Yu.E., Devyatova E.A., Tsaturova K.A. Females’ fertility preservation in malignancies. Problemy reproduktsii = Russian Journal of Human Reproduction 2020;26(4):68–76. (In Russ.). DOI: 10.17116/repro20202604168

16. Medical Eligibility Criteria for Contraceptive Use. 5th edn. Geneva: World Health Organization, 2015. 192 p.