European Society of Gynecological Oncology Task Force for Fertility Preservation: Clinical Recommendations for Fertility-Sparing Management in Young Endometrial Cancer Patients

Abstract

Endometrial cancer (EC) in young women of reproductive age is a relatively rare diagnosis. However, since in the modern era women delay their childbearing for a variety of social reasons, more and more women in the near future will be nulliparous and have a diagnosis of EC at the same time. Hence, a more conservative approach of EC is desirable to preserve fertility of these women, without compromising their survival. Recently, the number of studies reporting encouraging results on fertility-sparing management of EC with high dose of progestins is increasing. It seems that preserving the uterus and the ovaries in a carefully selected patient with EC confers only a very small risk combined with an enormous benefit. Selection of women suitable for such a conservative approach, as well as method of treatment, follow-up, recurrence, obstetric outcomes, and survival rates are very important parameters when consulting women with EC wishing to preserve their fertility. In this article, we try to elucidate all the previously mentioned aspects and formulate clinical recommendations, based on published data, about the most proper approach and consultation of these patients.

ESMO-ESGO-ESTRO Consensus Conference on Endometrial Cancer: Diagnosis, Treatment and Follow-up

“…The optimal method to obtain these histologic characteristics is dilatation and curettage (D&C)33; this procedure is superior to pipelle biopsy in terms of accuracy of the tumour grade 34…”

“…Conservative medical treatment for endometrial cancer is based on progestins with medroxyprogesterone acetate (MPA; 400–600 mg/day) or megestrol acetate (MA; 160–320 mg/day) 33. Few papers have addressed the use of LNG-IUD but preliminary data using such treatment (added to gonadotropin-releasing hormone [GnRH] analogues) seem to demonstrate similar remission and recurrence rates as oral progestins 37.…”

“…31 The optimal method to obtain these histologic characteristics is dilatation and curettage (D&C) 33 ; this procedure is superior to pipelle biopsy in terms of accuracy of the tumour grade. 34 The histological diagnosis should be reviewed by an expert pathologist to improve the accuracy of histological assessment (endometrial carcinoma or AH) and the reliability of tumour grading, 35 whereas the initial stage should be confirmed by enhanced pelvic magnetic resonance imaging (MRI) to exclude overt myometrial invasion, as well as adnexal or pelvic nodes involvement.…”

“…33 Few papers have addressed the use of LNG-IUD but preliminary data using such treatment (added to gonadotropinreleasing hormone [GnRH] analogues) seem to demonstrate similar remission and recurrence rates as oral progestins. 37 Assessment of response must be performed at 6 months with a new D&C and imaging.…”

Clinicopathologic Characteristics of Endometrial Cancer in Lynch Syndrome

“…Regarding sporadic ECs, conservative treatment by highdose oral progestins, that is, medroxyprogesterone acetate or megestrol acetate, seems acceptable for grade I endometrioid ECs without myometrial invasion. 39 The percentage of women who will respond to progestin treatment is approximately 75% after at least 6 months of treatment, 40 the recurrence rate of EC after conservative management is reported to be between 30% and 40%, 40,41 and overall survival appears good after hysterectomy is performed once family planning has been completed. These results must be transposed to routine practice with caution, because studies provide mainly retrospective lowquality evidence and did not include LS-related EC.…”