Fertility-Sparing Treatment for Endometrial Cancer or Atypical Endometrial Hyperplasia Patients With Obesity

Abstract

ObjectiveTo evaluate the efficacy and prognosis of fertility-sparing treatment on endometrial cancer (EC) and atypical endometrial hyperplasia (AEH) patients with BMI ≥ 30 kg/m2.MethodsA total of 102 EC or AEH patients with obesity who received fertility-preserving therapy in the Department of Obstetrics and Gynecology, Peking Union Medical College Hospital were included in our study. All patients were followed up regularly. Clinical characteristics, treatment outcomes, adverse events, and reproductive outcomes were collected and analyzed.ResultsA total of 88 (86.3%) patients achieved complete response (CR), 92.5% in AEH and 82.3% in EC, with 6 months (3–12 months) median CR time. High remission rates were found in patients who received gonadotropin-releasing hormone agonist (GnRHa)-based regimen, were younger than 35 years old, and lost more than 10% of their weight. Fifteen (17.0%) women had developed recurrence with a median recurrence time of 26 (8–52) months. Patients who received GnRHa regimen, lost more than 10% weight, received maintenance therapy, or conceived during the follow-up period had a low probability of recurrence. Of the patients with CR, 57 women attempted to get pregnant and 16 (28.1%) patients became pregnant, 7 (12.3%) of them successfully delivered and 4 (7.0%) were in pregnancy, while 5 (8.8%) of them miscarried.ConclusionFor obese patients with EC and AEH, fertility-preserving treatment can still achieve a promising response. Weight loss of more than 10% has a positive influence on response, recurrence, as well as pregnancy rates. GnRHa could be an option for obese women due to less effect on weight gain compared to progestin therapy.

Oncological and reproductive outcomes for gonadotropin-releasing hormone agonist combined with aromatase inhibitors or levonorgestrel-releasing intra-uterine system in women with endometrial cancer or atypical endometrial hyperplasia

“…Dong et al reported on three cases treated with GnRHa plus aromatase inhibitor in whom the disease remained stable for 2 years 22. In our previous study we used GnRHa combination therapy in 61 patients with obesity and 34 patients with recurrence, and achieved a high regression rate in these patients 23 24…”

“… 22 In our previous study we used GnRHa combination therapy in 61 patients with obesity and 34 patients with recurrence, and achieved a high regression rate in these patients. 23 24 …”

Progestin Resistance and Corresponding Management of Abnormal Endometrial Hyperplasia and Endometrial Carcinoma

“…GnRH-a reduces estrogen synthesis in the gonads, while letrozole inhibits estrogen synthesis in peripheral tissues; therefore, coadministration of letrozole and GnRH-a significantly downregulates estrogen levels in premenopausal women [ 173 ]. However, the GnRH-a regimen can lead to low pregnancy rates and reduced bone mass, which limits the widespread use of GnRH-a [ 174 ].…”

Fertility-sparing surgery: a hopeful strategy for young women with cancer

“…Despite this evidence, the lack of randomized clinical trials on the efficacy and safety of treatment in EC in relation to the risk of worsening oncological disease explains the cautious way to preserve fertility in these patients [ 62 ]. For obese patients with EC and AEH, a weight loss of over 10% and the administration of GnRH agonists would have an increased effect compared to progestin therapy [ 63 ].…”