Fertility preserving management of early endometrial cancer in a patient cohort at the department of women’s health at the university of Tuebingen

Abstract

Purpose To investigate the oncologic and reproductive outcome of a conservative treatment with progestin agents in early-stage grade 1 endometrial cancer (G1EC), grade 2 endometrial cancer (G2EC) or complex atypical hyperplasia (CAH) in young premenopausal women. Methods Women treated for early-stage endometrial cancer or atypical hyperplasia of the endometrium with a conservative therapy between 2006 and 2018 were enrolled in this retrospective analysis. Progestin agents were orally administered on a daily basis for 3 months for at least one cycle. Endometrial tissue was obtained by hysteroscopy and Dilatation & Curettage (D&C) being performed before and after end of treatment. Therapeutic response was assessed by pathological examination. Results A total of 14 patients were included. After treatment with progestin agents, 11 of these patients initially showed a complete or partial response. Three patients with early-stage endometrial cancer did not respond. Of the three patients with initially diagnosed atypical hyperplasia, none showed any remaining disease later. Of the eight patients with initially diagnosed endometrial cancer, who had responded to first treatment, three patients were re-diagnosed with endometrial cancer later. One patient with initial endometrial cancer became pregnant but aborted in the 10th week. Conclusion Due to its good efficacy, progestin agents offer a feasible therapeutic option in the fertility-preserving treatment of early-stage endometrial cancer in young premenopausal women. However, recurrence rate remains high. Therefore, a close follow-up is mandatory, also in responders. Patients should be informed of limitations and risks of conservative treatment. Yet after completion of family planning, hysterectomy should be performed.

Reproductive and Oncologic Outcomes in Young Women with Stage IA and Grade 2 Endometrial Carcinoma Undergoing Fertility-Sparing Treatment: A Systematic Review

“…The study selection process is displayed in Figure 1 . After the evaluation of the full texts, 22 papers that met the abovementioned inclusion criteria [ 23 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 ] were included in the present systematic review.…”

Oncological outcomes in fertility-sparing treatment in stage IA-G2 endometrial cancer

“…Among 168 potentially relevant records, six studies with a total of 124 participants were included in the systematic review and shown in Table 1 (9)(10)(11)(12)(13)(14). Four eligible articles were retrospective studies (9,10,13), whereas two articles were prospective trials (9,10).…”

“…FST consisted of dydrogesterone 10 mg for 3 months, but she did not respond to the treatment: her disease remained stable after a follow-up (FU) time of 6 months. The woman did not manage to conceive (12). Falcone et al examined 23 patients with intramucosal, G2 endometrioid EC with a mean FU duration of 35 months (10).…”

“…The endpoints of their study were CR, RR, and pregnancy and live birth rates. A total of 17 patients (74%) were administered with combined hysteroscopic resectoscope (HR) and levonorgestrel-releasing intra-uterine device (LNG-IUD) (12) (10). Among the six patients who did not achieve CR, one had persistence of disease at 6 months and underwent a hysterectomy.…”

The Advance and Correlation of KRAS Mutation With the Fertility-Preservation Treatment of Endometrial Cancer in the Background of Molecular Classification Application

“…Although the effectiveness of the fertility-spared treatment has now been widely recognized, the overall CR rate of conservative treatment is reported to fluctuate from 50.0 to 90.0% ( 13 – 15 ). Despite the different use of progestins and hysteroscopy, a center reported that even under the same treatment and histological type, the CR rate was only 40.0% in patients who were diagnosed as grade 1 endometrioid adenocarcinoma with minimal myometrial infiltration ( 16 ).…”