Fertility preservation in early-stage endometrial cancer and endometrial intraepithelial neoplasia: A single-center experience

Ayhan, Ali; Tohma, Yusuf Aytaç; Tunç, Mehmet

doi:10.1016/j.tjog.2020.03.014

Cited by 18 publications

(7 citation statements)

References 19 publications

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“…Operative hysteroscopy should be the preferred endometrial sampling method as co-existing endometrial polyps and bulky growths can be excised at the same time and its association with a higher remission rate. 14 In the present study 2 cases with endometrial polyps showed complete response probably due to complete excision at the time of endometrial sampling.…”

Section: Discussionsupporting

confidence: 51%

Challenges in the management of endometrial cancer and endometrial hyperplasia with atypia in sub-fertile patient: an emerging medical issue-our experience in a tertiary care centre

Reshme

Bafna

Prathima

2022

Int J Reprod Contracept Obstet Gynecol

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Background: The cases of endometrial hyperplasia with atypia/endometrial carcinoma with age below 40 years are rising and many are nulliparous at diagnosis. The purpose of the study was to study the oncological and obstetric outcome among young women with above mentioned endometrial pathology treated with fertility preserving approach.Methods: The retrospective cohort approach included 17 patients who visited Bhagwan Mahaveer Jain Hospital from January 2016 to January 2022 with a diagnosis of endometrial hyperplasia with atypia/endometrial carcinoma who met national comprehensive cancer network criteria. The records of all the patients included in the study have been reviewed retrospectively.Results: In our study 13/17 (76.47%) patients showed complete response to hormonal treatment. Conception rates are low (23.07%) even after reversal of the malignancy. Thirteen of 17 patients had associated polycystic ovarian syndrome. Three out of 17 (17.64%) had progressive disease, 5/13 (38.46%) cases had disease recurrence after initial remission out of which 3 had rechallenge with progestins with remission again.Conclusions: Levonorgestrol intra uterine system along with oral progestins is an effective combination as device might be useful in optimising the dose of oral progestins without the need for further escalation of dosage. Levonorgestrol intra uterine device or low dose oral progestins alone should be continued in responders not opting for conception as maintenance hormonal therapy. Hysterectomy should be advised if hormonal treatment fails, and also after completion of childbearing. Myometrial invasion may not be absolute contraindication for fertility sparing treatment. Molecular profiling of endometrial biopsy might help in better prognostication and treatment strategy.

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Section: Discussionsupporting

confidence: 51%

Challenges in the management of endometrial cancer and endometrial hyperplasia with atypia in sub-fertile patient: an emerging medical issue-our experience in a tertiary care centre

Reshme

Bafna

Prathima

2022

Int J Reprod Contracept Obstet Gynecol

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“…The combination of oral and intrauterine progestins has been proposed but there is insufficient evidence regarding its superiority over a single route of administration ( Hamilton et al , 2021b ). Similarly, several authors have proposed hysteroscopic resection before progestin-based treatment ( Wang et al , 2014 ; 2015 ; Falcone et al , 2017 ; Wang et al , 2017 ; Casadio et al , 2018 ; Giampaolino et al , 2019 ; Yang et al , 2019 ; Ayhan et al , 2020 ; Casadio et al , 2020 ; Mazzon et al , 2020 ; Atallah et al , 2021 ; Raffone et al , 2021 ). This could be justified in view of our findings, the diagnostic-therapeutic value of hysteroscopy, and the limited costs or risks associated with the procedure.…”

Section: Discussionmentioning

confidence: 99%

Chances of pregnancy and live birth among women undergoing conservative management of early-stage endometrial cancer: a systematic review and meta-analysis

Cappelletti

Humann

Torrejón

et al. 2021

Human Reproduction Update

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BACKGROUND Endometrial cancer is common and usually occurs after menopause, but the number of women diagnosed during reproductive age is increasing. The standard treatment including hysterectomy is effective but causes absolute uterine factor infertility. In order to avoid or postpone surgery, conservative management of endometrial cancer (CMEC) has been proposed for younger women who want to retain their fertility. OBJECTIVE AND RATIONALE The main objective of this study was to estimate the chances of pregnancy and live birth for women with early-stage endometrial cancer (EEC) who are managed conservatively for fertility preservation. SEARCH METHODS The PRISMA recommendations for systematic reviews and meta-analyses were followed. Structured searches were performed in PubMed, Embase and the Cochrane Library, from inception until 13 June 2021. Inclusion was based on the following criteria: group or subgroup of women with Clinical Stage IA, well-differentiated, endometrioid endometrial cancer (from now on, EEC); CMEC for fertility preservation; and reported frequencies of women achieving pregnancy and/or live birth after CMEC. The following exclusion criteria applied: impossibility to isolate/extract outcome data of interest; second-line CMEC for persistent/recurrent disease; CMEC in the presence of synchronous tumours; case reports; non-original or duplicated data; and articles not in English. Qualitative synthesis was performed by means of tabulation and narrative review of the study characteristics. Study quality was assessed with an ad hoc instrument and several moderator and sensitivity analyses were performed. OUTCOMES Out of 1275 unique records, 133 were assessed in full-text and 46 studies were included in the review. Data from 861 women with EEC undergoing CMEC were available. Progestin-based treatment was reported in all but three studies (93.5%; 836 women). Complete response to treatment was achieved in 79.7% of women, with 35.3% of them having a disease recurrence during follow-up. Of 286 pregnancies obtained after CMEC; 69.4% led to live birth (9% of them multiple births) and 66.7% were achieved through fertility treatment. Based on random-effects meta-analyses, women treated with progestin-based CMEC have a 26.7% chance of achieving pregnancy (95% CI 21.3–32.3; I2 = 53.7%; 42 studies, 826 women) and a 20.5% chance to achieve a live birth (95% CI 15.7–25.8; I2 = 40.2%; 39 studies, 650 women). Sample size, average age, publication year, study design and quality score were not associated with the outcomes of progestin-based CMEC in moderator analyses with meta-regression. However, mean follow-up length (in months) was positively associated with the chances of pregnancy (regression coefficient [B] = 0.003; 95% CI 0.001–0.005; P = 0.006) and live birth (B = 0.005; 95% CI 0.003–0.007; P < 0.001). In sensitivity analyses, the highest chances of live birth were estimated in subsets of studies including only women of age 35 or younger (30.7%), the combination of progestins with hysteroscopic resection (30.7%), or at least 3 years of follow-up (42.4%). WIDER IMPLICATIONS Progestin-based CMEC is viable for women with well-differentiated, Clinical Stage 1A, endometrioid endometrial cancer who want to preserve their fertility, but there is room for improvement as only one-fifth of them are estimated to achieve live birth according to this meta-analysis. Further investigations on prognosis-driven selection, hysteroscopic resection and long-term surveillance are arguably needed to improve the reproductive outcomes of CMEC.

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Section: Resultsmentioning

confidence: 99%

“…Among gynecologic cancers, endometrial cancer represents the main neoplasm and the fourth most common in women. 31 Approximately 6.5% of patients are younger than 45 years old, many of them are nulliparous and have a desire to conceive 32 ; if endometrial cancer is in the early stage and low grade, hormone therapy can be considered. 33 For patients with grade 1 endometrial adenocarcinoma without any sign of myometrial invasion at image staging (Transvaginal Ultrasound or Magnetic Resonance Imaging) 34 or lymphovascular space invasion (LVSI), progestins can be considered and it can be administered orally or locally through a progestin-releasing intrauterine device (IUD).…”

Section: Fertility Sparing Treatment In Endometrial Cancermentioning

confidence: 99%

The complex relationship between infertility and female genital tract cancer: A review

et al. 2021

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Introduction: The link between female infertility and gynecological cancer has always been a debated and challenging topic. Although cervical cancer has the worst impact on female fertility, as it is usually diagnosed in patients of reproductive age, endometrial and ovarian cancer are also diagnosed and treated often in relatively younger patients in which fertility preservation is a relevant issue. The aim of this review is to highlight the correlation between therapy for female infertility and the developing cancer’s risk and to describe the fertility sparing treatments in gynecological oncology. Material and methods: A systematic review of the literature through the main scientific search engines (PubMed and Google Scholar) was performed. We selected the most relevant articles based on the largest case series and the latest updates. All selected documents have been listed in the references. Results: Fifty-six relevant articles published between 1996 and 2019 were identified. Results from the available evidence report no significant increased risk of endometrial, cervical, and ovarian cancer in patients having infertility treatments. In young patients diagnosed with gynecological cancer, preservation of fertility is a personalized choice depending on several factors (type, stage, age and desire to conceive, safety of the treatment, and feasibility of fertility sparing surgery). For ovarian cancer FIGO stage IA G1, IA G2 (grade), and IC G1; for endometrial adenocarcinoma grade 1 with no lymphovascular space invasion (LVSI) or myometrial invasion and for early-stage cervical cancer (FIGO stage 2018: IA1-IB1), fertility sparing treatment is possible. The role of fertility sparing treatment with the increase of personalization of therapies therapy is always a theme of discussion and research. Conclusion: At present data regarding the risk of gynecological cancers after infertility treatments are reassuring. Careful evaluation of female fertility-sparing options in young women interested by ovarian, endometrial, or cervical tumors should be carried out involving a multidisciplinary team and ensuring safety and efficacy.

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Fertility preservation in early-stage endometrial cancer and endometrial intraepithelial neoplasia: A single-center experience

Cited by 18 publications

References 19 publications

Challenges in the management of endometrial cancer and endometrial hyperplasia with atypia in sub-fertile patient: an emerging medical issue-our experience in a tertiary care centre

Challenges in the management of endometrial cancer and endometrial hyperplasia with atypia in sub-fertile patient: an emerging medical issue-our experience in a tertiary care centre

Chances of pregnancy and live birth among women undergoing conservative management of early-stage endometrial cancer: a systematic review and meta-analysis

The complex relationship between infertility and female genital tract cancer: A review

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