Conservative management of endometrial cancer: a survey amongst European clinicians

Russa, Mariaclelia La; Zapardiel, Ignacio; Halaška, Michael; Zalewski, Kamil; Laky, R; Dursun, Polat; Lindquist, David; Sukhin, Vladyslav; Polterauer, Stephan; Biliatis, Ioannis

doi:10.1007/s00404-018-4820-7

Cited by 27 publications

(25 citation statements)

References 19 publications

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“…Another area of controversy is the duration of progestative treatment, which varies as published by different authors, as well as the surveillance of these patients with serial endometrial biopsies (Colombo et al, 2016; La Russa et al, 2018). Following the first assessment at 6 months, surveillance was done yearly for 5 years with an outpatient pipelle biopsy.…”

Section: Discussionmentioning

confidence: 99%

A case of incidental endometrial adenocarcinoma diagnosed in early pregnancy and managed conservatively

Rizzuto

Nicholson

Dickinson

et al. 2019

Gynecologic Oncology Reports

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We report a 29-year old nulliparous woman diagnosed with a grade 1 endometrioid adenocarcinoma of the endometrium arising from an atypical polypoid adenomyoma, while being investigated for a suspected threatened miscarriage at 7 weeks gestation. She presented complaining of vaginal bleeding and a small amount of soft tissue in the cervical os was found and sent for histology. An ultrasound scan was performed, which confirmed an intrauterine ongoing pregnancy. The patient had no further episodes of unscheduled bleeding. After the confirmed histological diagnosis an MRI scan was requested, and there were no evidence of myometrial invasion or distant metastasis. The patient was seen at each trimester, remained asymptomatic throughout the pregnancy and had a normal delivery at term. There was no evidence of any residual endometrioid adenocarcinoma in the post-delivery specimen. Six weeks post-natally an endometrial biopsy was performed, which was normal. She is still in remission over a period of 8 years follow-up. Endometrial adenocarcinoma in young pregnant women is a rare clinical circumstance. This case shows that conservative management in young women is possible including in a case of an incidental diagnosis in pregnancy.

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Section: Discussionmentioning

confidence: 99%

A case of incidental endometrial adenocarcinoma diagnosed in early pregnancy and managed conservatively

Rizzuto

Nicholson

Dickinson

et al. 2019

Gynecologic Oncology Reports

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show abstract

“…Women with EC at age <50 years should be referred for genetic counseling and screened for Lynch syndrome 52 (Table 2). Many providers consider Lynch syndrome a contraindication to conservative management as it is not an estrogen-driven process; 76 proceeding with fertility-sparing treatment in patients with Lynch should only occur after thorough counseling and shared decision-making.…”

Section: Evaluating Candidacy For Fertility-sparing Surgerymentioning

confidence: 99%

“…Median time to EC regression is 6-9 months. 48,50,76 Imaging 48 If EC persists after 6 months of progestin, pelvic MRI is recommended to evaluate for myometrial invasion and nodal/ovarian metastasis before continuing fertility-sparing treatment.…”

Section: Endometrial Cancer (Ec) 48mentioning

confidence: 99%

Fertility-sparing Surgery for Patients with Cervical, Endometrial, and Ovarian Cancers

Kohn¹,

Kashi²,

Acosta-Torres³

et al. 2021

Journal of Minimally Invasive Gynecology

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“…21 Nearly 90% of gynecologic oncologists surveyed would recommend hysterectomy once childbearing was completed for women initially treated with uterinepreservation. 22…”

Section: Interpretation Of Findingsmentioning

confidence: 99%

National patterns of care and fertility outcomes for reproductive-aged women with endometrial cancer or atypical hyperplasia

Harrison

et al. 2019

American Journal of Obstetrics and Gynecology

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BACKGROUND: Although it is uncommon, the incidence of endometrial cancer and atypical hyperplasia among reproductive-aged women is increasing. The fertility outcomes in this population are not well described. OBJECTIVE: We aim to describe the patterns of care and fertility outcomes of reproductive-aged women with endometrial cancer or atypical hyperplasia. MATERIALS AND METHODS: A cohort of women aged 45 years with endometrial cancer or atypical hyperplasia diagnosed in 2000 to 2014 were identified in Truven Marketscan, an insurance claims database of commercially insured patients in the United States. Treatment information, including use of progestin therapy, hysterectomy, and assisted fertility services, was identified and collected using a combination of Common Procedural Terminology codes, International Statistical Classification of Diseases and Related Health Problems codes, and National Drug Codes. Pregnancy events were identified from claims data using a similar technique. Patients were categorized as receiving progestin therapy alone, progestin therapy followed by hysterectomy, or standard surgical management with hysterectomy alone. Multivariable logistic regression was performed to assess factors associated with receiving fertility-sparing treatment. RESULTS: A total of 4007 reproductive-aged patients diagnosed with endometrial cancer or atypical hyperplasia were identified. The majority of these patients (n ¼ 3189; 79.6%) received standard surgical management. Of the 818 patients treated initially with progestins, 397 (48.5%) subsequently underwent hysterectomy, whereas 421 (51.5%) did not. Patients treated with progestin therapy had a lower median age than those who received standard surgical management (median age, 36 vs 41 years; P < .001). The proportion of patients receiving progestin therapy increased significantly over the observation period, with 24.9% treated at Harrison et al. Fertility conservation and pregnancy outcomes in young women with endometrial cancer or hyperplasia. Am J Obstet Gynecol 2019.

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Conservative management of endometrial cancer: a survey amongst European clinicians

Abstract: Our study shows that conservative management is increasingly offered to women affected by early stage EC wishing to preserve their fertility. Further studies and joint registries are required to evaluate safety and effectiveness of this approach in this probably growing number of patients.

Cited by 27 publications

References 19 publications

A case of incidental endometrial adenocarcinoma diagnosed in early pregnancy and managed conservatively

A case of incidental endometrial adenocarcinoma diagnosed in early pregnancy and managed conservatively

Fertility-sparing Surgery for Patients with Cervical, Endometrial, and Ovarian Cancers

National patterns of care and fertility outcomes for reproductive-aged women with endometrial cancer or atypical hyperplasia

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