Conservative management of patients with early endometrial carcinoma: a systematic review

Abstract

A conservative approach in these patients can offer reasonable oncological security and the opportunity of fulfilling their maternal desires in selected cases. However, consideration should be taken regarding the potential adverse outcomes that have been recently published in the literature.

Preserving fertility in young patients with endometrial cancer: current perspectives

“…All but one patient were disease free at the end of the study (one patient was undergoing the third round of progestin treatment for multirecurrent disease). The few other published studies on outcomes of repeat fertility-sparing treatment have reported similar findings,16,47,55,64,65,86 which suggests that progestin retreatment in the setting of initial complete response may be feasible and safe, albeit a temporary approach, for women who decline definitive treatment at the time of uterine-confined EC recurrence.…”

“…The range of response rates published in the literature varies, with some studies reporting response rates between 42% and 62%48,54,60,68 and others reporting higher rates of 78%–100% 52,62,65,66,76,80. Factors that could account for these differences include 1) variations in treatment duration, as longer treatment durations could result in higher response rates,15,64 and 2) differences in definitions of “complete response”.…”

“…As some women may still wish to maintain their reproductive potential despite recurrence, repeat fertility-sparing treatment may be considered. However, data supporting repeat progestin therapy in the setting of recurrent EC are even more limited than in the primary setting 16,47,55,64,65,76,85,86. In 2013, Park et al85 reported on the safety and efficacy of progestin retreatment in a cohort of 33 women with recurrent uterine-confined EC after initial successful progestin treatment.…”

“…Therefore, once women who have been successfully treated with progestins have completed childbearing, they should undergo definitive surgery. Also, given the limited data on the safety of progestin retreatment in the setting of recurrent disease,16,47,55,64,65,76,85,86 those who experience recurrence should also undergo hysterectomy, BSO, and/or lymphadenectomy. Women who decline definitive treatment after appropriate counseling should be carefully followed.…”

Hysteroscopic surgery for conservative management in endometrial cancer: a review of the literature

“…In the case of Mazzon and Shan a review by two pathologists specialising in gynaecology was carried out independently. In a previous review carried out by our group, we saw that according to the literature, there is a difference between inter and intraobserver of 40% [ 15 ], which is why a review by two pathologists is an established recommendation. In the study of two cases by Marton et al [ 14 ] there is no mention of hormonal receptors or of histological confirmation.…”