Fertility-sparing therapy for young women with endometrial cancer

Frumovitz, Michael; Gershenson, David M.

doi:10.1586/14737140.6.1.27

Cited by 15 publications

(8 citation statements)

References 42 publications

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“…The rate of coexisting ovarian malignancies and endometrial cancer in young women (<45 years) varies between 5 and 29% (12, 40–43). Therefore, this pre-treatment procedure is an essential step in the evaluation of endometrial lesion as suggested by several authors (44, 45). In our retrospective series, no ovarian malignancies were found.…”

Section: Discussionmentioning

confidence: 99%

Fertility Sparing Treatment in Patients With Early Stage Endometrial Cancer, Using a Combination of Surgery and GnRH Agonist: A Monocentric Retrospective Study and Review of the Literature

et al. 2018

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Objectives: To evaluate the efficacy and safety of gonadotropin-releasing hormone (GnRH) agonist after endometrial resection in women suffering early stage endometrial carcinoma (EC) and/or endometrial intra-epithelial neoplasia (EIN).Design: A retrospective review of clinical files between January 1999 and December 2016.Setting: University hospital.Patients: Eighteen women younger than 41 years with grade 1 endometrial carcinoma (G1EC) and/or Endometrial intra-epithelial neoplasia (EIN). Interventions: All patients received GnRH agonist for 3 months after an endometrial resection combined with a laparoscopy to exclude concomitant ovarian tumor and/or other extra-uterine disease. The patient underwent a follow-up of 3 months interval with endometrial sampling by hysteroscopy.Main Outcome Measure(s): The recurrence rate and the pregnancy rate after fertility sparing treatment.Results: We identified 9 patients with EIN (50%), 7 patients with G1EC (38.9%), 1 with combined histology (5.5%), and 1 with G2EC (5.5%). After a median follow-up of 40.7 months, 12 patients conserved their uterus (66.7%), and 8 (53.3%) patients were pregnant with a total of 14 pregnancies among those who tried to become pregnant. We observed a complete response rate in 12 patients (66.7%) but 3 of these patients relapsed (25%). We also found a stable disease in 6 patients (33.3%).Conclusions: Compared with other fertility sparing treatments, GnRH agonist after surgery is an effective fertility-sparing strategy for women with EIN and/or G1EC. We recommend hysterectomy once a family has been completed even if the literature does not clearly lead to radical surgery.

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Section: Discussionmentioning

confidence: 99%

Fertility Sparing Treatment in Patients With Early Stage Endometrial Cancer, Using a Combination of Surgery and GnRH Agonist: A Monocentric Retrospective Study and Review of the Literature

et al. 2018

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“…According to the results of one meta-analysis, contrast-enhanced MRI is better than non-contrast-enhanced MRI, CT scan or pelvis ultrasound in diagnosing the depth of myometrial invasion [22]. However, the accuracy of the current imaging techniques for excluding invasion of the inner half of the myometrium in cases of G1-EC is low [23]. Pelvic ultrasound is a less expensive tool but needs to be performed by an experienced physician to obtain accuracy similar to MRI [24].…”

Section: Controversial Topicsmentioning

confidence: 99%

“…This represents a different scenario and constitutes an absolute contraindication to fertility-sparing treatment. Several authors have proposed laparoscopy for diagnosis before EC treatment [8,6,23,30] in order to rule out the coexistence of an ovarian cancer or metastatic EC. However, limitations of laparoscopy include its application to cases with microscopic ovarian lesions only and the increased likelihood of adhesion formation, which would potentially decrease future fertility.…”

Section: Controversial Topicsmentioning

confidence: 99%

Controversies of the Hormonal Conservative Treatment of Endometrial Cancer

Minig

Franchi

Bernabe

et al. 2013

Gynecol Obstet Invest

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Background: Hysterectomy plus salpingo-oophorectomy represents the standard treatment for patients with well-differentiated endometrial cancer (EC) limited to the endometrium. It is estimated that over 5% of EC are diagnosed in nulliparous women aged 35-44 years. In addition, EC can affect obese women with diabetes, hypertension and other comorbidities increasing the surgical risk. Methods: This article reviews the English literature in PubMed regarding hormonal treatment of EC. Results: Use of hormonal therapies has resulted in complete remission in 60-70%; many of these women were able to achieve full-term pregnancies, and in case of contraindication to surgery, resection could be avoided. Several topics, however, such as patient selection, interobserver histologic evaluation, the type/duration of hormonal treatment, modality of evaluation before treatment and surveillance after treatment, which are still subject to controversy, are therefore discussed in this paper. Conclusion: Uterus-sparing treatment of well-differentiated EC limited to the endometrium is feasible and has acceptable efficacy in women with increased surgical risk or those who wish to preserve their fertility. Although the methods applied to determine disease extent beyond the endometrium are still unsatisfactory, patient selection is a crucial factor determining the outcome of treatment. However, women must be fully informed about the possibility of treatment failure and the necessity of a close follow-up after therapy.

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“…3 The younger group of women with endometrial carcinoma is frequently nulligravida with a history of infertility and a strong desire to preserve fertility. 4 Fortunately, the tumors in these patients tend to be well differentiated with no myometrial invasion and are associated with a favorable prognosis. 5 Because of the particularly good prognosis for premenopausal patients with endometrial cancer and because most of the young patients whose conditions are diagnosed with endometrial cancer also experience infertility, some attempts have been made to treat these patients with progestins rather than with surgery.…”

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confidence: 99%