Fertility sparing treatment in patients with endometrial cancer (FERT-ENC): a multicentric retrospective study from the Spanish Investigational Network Gynecologic Oncology Group (SPAIN-GOG)

Lago, Víctor; Marina, Tiermes; Modrego, M Laseca; Gil-Ibáñez, Blanca; Rodríguez, José Ramón; Domingo, Javier; Minig, Lucas; Padilla-Iserte, Pablo; Sanchez, O Arencibia; Ferichola, Manuela Sala; Munmanny, Merixell; Salamanca, B. Martín; Iacoponi, Sara; Cabrera, Sílvia; Coronado, Pluvio; Utrilla-Layna, J.; Bataller, A.; Fiol, Gabriel; Corbalán, Shiana; Espinosa, Elena; Gurrea, Marta; Munoz, Maria; Martinez, Maria Dolores Jimenez; Rincón, M. T. Rodríguez; Matute, Luis

doi:10.1007/s00404-021-06375-2

Cited by 8 publications

(7 citation statements)

References 23 publications

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“…However, they can be partially reduced through intrauterine administration. An LNG-IUD has been shown to be effective alone in FST in most cases of early stage EC [ 45 , 46 ].…”

Section: Discussionmentioning

confidence: 99%

Sparing Is Caring: Hormonal Retreatment in Women with Recurrent Endometrial Cancer after Fertility Preservation Management—A Single Centre Retrospective Study

et al. 2023

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Fertility-sparing treatment (FTS) of endometrial cancer (EC) has a high rate of remission but also a high rate of relapse (10–88%). Many women still wish to conceive at the time of relapse, but results regarding retreatment are still lacking. This study aims to evaluate the safety, oncological and pregnancy outcomes of repeated FST in women with recurrent EC. This is a retrospective single-center study that recruited patients who had uterine recurrence after achieving a complete response (CR) with FST for FIGO stage IA, well-differentiated (G1), endometrioid EC. All eligible women underwent a second FST. Among 26 patients with recurrence, 6 decided to receive a hysterectomy and 20 received fertility-sparing retreatment. In total, 17 out of 20 women (85%) achieved a CR in a median time of 6 months. A total of 2/20 women showed a stable disease and continued the treatment for a further 6 months and finally achieved a CR. In total, 1/20 women showed disease progression and underwent demolitive surgery. After relapse and a CR, 14 patients attempted to become pregnant, among whom 7 became pregnant (pregnancy rate 50%—life birth rate 29%). Secondary FST is a safe and effective option for women who desire to preserve fertility after the recurrence of early-stage EC.

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“…However, they can be partially reduced through intrauterine administration. An LNG-IUD has been shown to be effective alone in FST in most cases of early stage EC [ 45 , 46 ].…”

Section: Discussionmentioning

confidence: 99%

Sparing Is Caring: Hormonal Retreatment in Women with Recurrent Endometrial Cancer after Fertility Preservation Management—A Single Centre Retrospective Study

et al. 2023

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“…Endometrial cancer in reproductive-age patients is uncommon, with only 4–5% of cases occurring in women under 40 years of age [3]. Around 70% of cases are confined at the time of diagnosis with a 5-year survival rate >95% [2].…”

Section: Safety Of Fertility-sparing Treatments and Assisted Reproduc...mentioning

confidence: 99%

“…As these patients may show infertility due to obesity and anovulation, oocyte vitrification for later in vitro fertilization (IVF), while awaiting response to hormone treatment, may play a role to shorten time to pregnancy. In patients without diagnosis of infertility, success rates in women attempting pregnancy are high, with a 78% live birth rate reported in the most recent retrospective analysis performed in Spain [3]. This may diverge from live-birth rate of 20–46% given in most studies due to the fact that in the Spanish review only people attempting pregnancy were included in the analysis [10], possibly biasing the results as patients without a complete response or rapidly relapsing were not given the chance to become pregnant.…”

Section: Safety Of Fertility-sparing Treatments and Assisted Reproduc...mentioning

confidence: 99%

“…Complete response rates range from 55% to 76% after fertility-sparing treatment, with recurrence rates of 20-47% [10]. Levonorgestrel intrauterine device has shown better response rate compared to oral regimes in retrospective studies, although several randomized controlled trials are currently underway to prospectively evaluate the actual efficacy of each regime [3].…”

Section: Fertility-sparing Options In Endometrial Cancermentioning

confidence: 99%

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Safety of assisted reproductive techniques in gynecological cancer patients

Caballero

Domingo

Garcia-Velasco

2023

Current Opinion in Oncology

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Purpose of review Gynecological cancer is a very important cause of comorbidity and mortality in women. The current delay in motherhood is increasing the incidence of women under 40 years of age that have not yet achieved their maternity goals when they are diagnosed and standard treatment negatively impacts the reproductive potential of cancer survivors. In this review, we update the information available about the safety of fertility-sparing treatments in young gynecological cancer patients, as well as the safety and efficacy of assisted reproductive techniques (ART) in such group. We also evaluate the long-term gynecological cancer risk in women requiring ART. Recent findings Although eligibility criteria continue to be very strict, there are more and more reports of fertility-sparing approaches outside of what traditionally has been considered safe. Molecular assessment is starting to be used in the selection of appropriate candidates. Data increasingly shows the long term safety and the efficacy of ART and pregnancy in these patients. Summary Appropriate selection is key to safely preconize fertility-sparing alternatives. Because subfertility may be a result of these procedures, ART could be indicated in this setting. Neither ART nor pregnancy appear to increase recurrences or affect survival rates.

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“…Therefore, progestin therapy has been evaluated as "feasible for selected women to satisfy their reproductive wishes" [17][18][19]. Other applied therapy alternatives for early well-differentiated endometrial carcinoma in patients with fertility desire include hysteroscopic resection followed by endocrine therapy and/or intrauterine devices [20,21]. According to the current German guideline for endometrial carcinoma, in cases of endometrioid cT1a, G1, p53-wildtype, and L1CAM-negative carcinoma without myometrial invasion and with a desire for fertility preservation therapy with medroxyprogesterone acetate (MPA) (200-250 mg/day orally) or megestrol acetate (160-200 mg/day orally) or a levonorgestrel intrauterine device can be offered after appropriate counseling [1].…”

Section: Introductionmentioning

confidence: 99%

Curative Polyendocrine Therapy in a 21-year-Old Patient with Endometrial Carcinoma: Case Report and Review of the Literature

Schäffler¹,

Dimpfl²,

Schochter³

et al. 2023

Oncol Res Treat

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A 21-year-old patient diagnosed with atypical endometrial hyperplasia and suffering from hypermenorrhea and dysmenorrhea for several months was initially treated with MPA ( Medroxyprogesterone acetate). A control dilation and curettage (D&C) after 4 months revealed early-stage, well-differentiated endometrioid endometrial carcinoma. Despite national guidelines recommending a hysterectomy, the nulliparous patient with a desire to have children requested an organ-preserving procedure and underwent polyendocrine therapy with Letrozole, Everolimus, Metformin and Zoladex. 43 months after diagnosis, the patient gave birth to a healthy child. To date, there have been no signs of recurrence. This case suggests that triple endocrine therapy may be an option for selected patients with early endometrial cancer and a desire for fertility-sparing therapy.

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Fertility sparing treatment in patients with endometrial cancer (FERT-ENC): a multicentric retrospective study from the Spanish Investigational Network Gynecologic Oncology Group (SPAIN-GOG)

Cited by 8 publications

References 23 publications

Sparing Is Caring: Hormonal Retreatment in Women with Recurrent Endometrial Cancer after Fertility Preservation Management—A Single Centre Retrospective Study

Sparing Is Caring: Hormonal Retreatment in Women with Recurrent Endometrial Cancer after Fertility Preservation Management—A Single Centre Retrospective Study

Safety of assisted reproductive techniques in gynecological cancer patients

Curative Polyendocrine Therapy in a 21-year-Old Patient with Endometrial Carcinoma: Case Report and Review of the Literature

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