Fertility-sparing treatment for intramucous, moderately differentiated, endometrioid endometrial cancer: a Gynecologic Cancer Inter-Group (GCIG) study

Abstract

Objective: 'The Endometrial Cancer Conservative Treatment (E.C.Co.). A multicentre archive' is a worldwide project endorsed by the Gynecologic Cancer Inter-Group, aimed at registering conservatively treated endometrial cancer (EC) patients. This paper reports the oncological and reproductive outcomes of intramucous, G2, endometrioid EC patients from this archive. Methods: Twenty-three patients (Stage IA, G2, endometrioid EC) were enrolled between January 2004 and March 2019. Primary and secondary endpoints were, respectively, complete regression (CR) and recurrence rates, and pregnancy and live birth rates. Results: A median follow-up of 35 months (9-148) was achieved. Hysteroscopic resection (HR) plus progestin was adopted in 74% (17/23) of cases. Seventeen patients showed CR (median time to CR, 6 months; 3-13). Among the 6 non-responders, one showed persistence and 5 progressed, all submitted to definitive surgery, with an unfavorauble outcome in one. The recurrence rate was 41.1%. Ten (58.8%) complete responders attempted to conceive, of whom 3 achieved at least one pregnancy with a live-birth. Two out of the 11 candidate patients underwent definitive surgery, while the remaining 9 have so far refused. To date, 22 patients show no evidence of disease, and one is still alive with disease. Conclusions: Fertility-sparing treatment seems to be feasible even in G2 EC, although caution should be kept considering the potential pathological undergrading or non-endometrioid

Major clinical research advances in gynecologic cancer in 2020

“…And, in the hormonal treatment indications of early endometrial cancer, there was still lack of evidence about whether hormonal treatment can be a safe option for endometrial cancer patients with moderately differentiated tumor grade. A Gynecologic Cancer Inter-Group study observed that CR was achieved in 43.4%, 56.5% and 65.2% of the patients after 6, 9, and 12 months from the initiation of progestin, respectively, achieving 73.9% of an overall CR rate [ 45 ]. Although the sample size is very small (23 patients and all were grade 2) the CR rates seem to be identical with the results from previous studies in patients with grade 1.…”

Pushing the envelope: expanding fertility sparing treatment of endometrial cancer

“…In this issue of the Journal of Gynecologic Oncology , Falcone and colleagues [ 9 ] report on the oncologic and reproductive outcomes in 23 patients with grade 2 endometrial cancer from multiple centers. Patients were treated with a combination of hysteroscopic resection plus progestin therapy with LNG-IUD, megestrol acetate or norethisterone acetate.…”

Comments on: Fertility-sparing treatment for intramucous, moderately differentiated, endometrioid endometrial cancer: a Gynecologic Cancer Inter-Group (GCIG) study

“…Recently, Falcone et al [ 1 ] reported the oncologic and reproductive outcomes of fertility-sparing treatment in women with endometrium-confined, grade 2, endometrioid endometrial cancer using Gynecologic Cancer Inter-Group (GCIG)-endorsed registry. This is the largest series ever reported on the grade 2, endometrial cancer [ 1 ]. The complete response rate (73.9%) and recurrence rate (41.1%) in this report was similar with those obtained in grade 1 endometrial cancer [ 1 ].…”

“…This is the largest series ever reported on the grade 2, endometrial cancer [ 1 ]. The complete response rate (73.9%) and recurrence rate (41.1%) in this report was similar with those obtained in grade 1 endometrial cancer [ 1 ]. Therefore, it seems that fertility-sparing treatment can be a reasonable treatment option for women with endometrium-confined, grade 2, endometrioid endometrial cancer.…”

“…However, even if the cancer is confined to the uterus and there is no extra uterine metastasis on metastasis on MRI and PET-CT, there are about 7% of cases where lymph node metastasis is found in postoperative pathology [ 3 ]. In Falcone et al's study [ 1 ], there was a case in whom lymph node metastasis occurred during fertility-sparing treatment. Of course, in this case, it is not known whether there was lymph node metastasis even at the time of initial diagnosis.…”