Conservative management of young patients with endometrial highly-differentiated adenocarcinoma

Abstract

Endometrial cancer is uncommon in young women. However, almost 5% of patients are younger than 40 years old. Progestins such as medroxyprogesterone acetate (MPA) and megestrol acetate (MA), have been used as a fertility-sparing approach in this group of patients, with different dose regimens of cyclic (14 days every month) or continuous therapy successfully used. According to the present data, the overall response rate was 73% in a median time of 4 months (range 1-15 months). Endometrial biopsy every 3 months was the common approach to evaluate the patient's response during the treatment. The relapse rate was 36% in a median follow-up time of 22 months (range 6-73 months). Overall, 40% of patients who responded to the treatment successfully, conceived. Half of the patients used assisted reproductive technology to achieve an immediate pregnancy. Although, there are no definite recommendations concerning the conservative management of young patients with early stage endometrial cancer, progestin agents may be used in a selected group of patients for fertility-sparing reasons. After childbearing is completed, hysterectomy remains the standard treatment.

The Effects of Cancer Therapy on Women’s Fertility: What do We Know Now?

“…In a systemic review and meta-analysis of three studies done by Xu et al [32] comparing 587 patients with early cervical cancer who underwent either radical trachelectomy or radical hysterectomy, no significant differences were noted between the two groups in recurrence rate (1. 38 is below 3.8% [33]. Risk of recurrence is dependent upon tumor size, presence of positive nodes, lymphovascular space involvement, deep stromal invasion and unfavorable histology.…”

“…Risk of concurrent ovarian malignancy is present in 11-29% patients [37]. Spontaneous pregnancy rates of 40% and live birth rates up to 47% have been reported following progesterone treatment [38]. If spontaneous conception does not occur within a reasonable time-assisted reproductive technique (ART) is advised, as definitive surgery needs to be planned as soon as child bearing is complete.…”

Fertility-preservation in endometrial cancer: is it safe? Review of the literature

“…Premenopausal women appear to have a higher rate of low-grade tumors and lower stage of disease resulting in a favorable 5-year disease-specific survival rate of 93%, in contrast to older patients (86%) (Crissman et al .,1981; Kalogiannidis et al ., 2011). …”

Oncofertility in Canada: Gonadal Protection and Fertility-Sparing Strategies

“…Although standard management would involve removal of the reproductive organs 28 , progestin agents have been used in effort to spare fertility in well-differentiated early disease with no evidence of progression 28,29 . Response to treatment has been high (rates of 73%-81%), but not absolute [28][29][30][31] . Recurrence rates are also appreciable (18%-40% with follow-up times up to 357 months) [28][29][30][32][33][34] .…”

“…Response to treatment has been high (rates of 73%-81%), but not absolute [28][29][30][31] . Recurrence rates are also appreciable (18%-40% with follow-up times up to 357 months) [28][29][30][32][33][34] . Although progestin management of early endometrial carcinoma has shown success (recent pregnancy rates of 40% and subsequent live birth rates up to 47% 30 ), this management route is evidently not without risk.…”