Long-Term Oncologic and Reproductive Outcomes in Young Women With Early Endometrial Cancer Conservatively Treated: A Prospective Study and Literature Update

Laurelli, Giuseppe; Falcone, Francesca; Gallo, Marianna; Scala, Felice; Losito, Simona; Granata, Vincenza; Cascella, Marco; Greggi, Stefano

doi:10.1097/igc.0000000000000825

Cited by 55 publications

(47 citation statements)

References 37 publications

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“…HR also helps improve the efficacy of progestogen due to less tumor burden. As a result, a higher regression rate and a shorter time between diagnosis and regression [ 72 ]. Some complication of HR such as endometrial destruction, intrauterine adhesion, which can affect the reproductive outcomes of young patients desire to preserve their fertility as mentioned before [ 73 ].…”

Section: Discussionmentioning

confidence: 99%

“…Meanwhile, diagnostic hysteroscopy can found the uterine synechia caused by serial dilation and curettage (D&C) at follow-up and operate hysteroscopic adhesiolysis [ 22 ]. A recent prospective study focused on HR and progestin therapy reached a live birth rate of 50% in all treated patients and 86.6% for women who tried to conceive with no complications [ 72 ]. Another problem may be the dissemination of cancerous cells into the peritoneal cavity during hysteroscopy, it is reported that it didn't risk recurrence rate and the long-term prognosis is unclear [ 16 , 74 , 75 ].…”

Section: Discussionmentioning

confidence: 99%

“…Far from satisfactory, the low fertility rates can be explained by the fact that many women diagnosed with eEC or CAH are overweight, obese, anovulation or have polycystic ovarian syndrome all of which significantly impact the pregnancy rate [ 1 , 22 , 24 , 76 ]. It is reported that a higher pregnancy and live birth rate in use of Assisted Reproductive Technology(ART) than spontaneous conception in young women with EC [ 14 , 40 , 72 ]. Patients who reached regression with fertility sparing therapy, immediately conceive should be suggested especially under ART.…”

Section: Discussionmentioning

confidence: 99%

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Comparison among fertility-sparing therapies for well differentiated early-stage endometrial carcinoma and complex atypical hyperplasia

Zhang

Kanis

et al. 2017

Oncotarget

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ObjectiveTo compare fertility-sparing therapies including oral progestogens, hysteroscopic resection (HR), and the levonorgestrel- releasing intrauterine system (LNG-IUS) in achieving disease regression, recurrence and live birth rate in well differentiate early-stage endometrial carcinoma (eEC) and complex atypical hyperplasia(CAH).Study DesignThis was a meta-analysis of previous studies focus on the fertility-sparing therapy for well differentiate early-stage endometrial carcinoma (eEC) and complex atypical hyperplasia (CAH).Date SourcesMedline, the Cochrane Library and Embase was searched with the terms and Synonyms: words similar to eEC and CAH with therapies associated with fertility-sparing.Main Outcome MeasuresThe number of all patients accepted fertility sparing therapies, patients got regressed, relapsed and delivered were extracted from each study, and the regression, recurrence, and live birth rate of each study were calculated. The regression, recurrence and live birth rates between each two interventions were compared with the aid of meta-regression in packages of “meta” and ”meta for” written in R.ResultsFifty-four studies reported fertility sparing therapies in young women with eEC and CAH were included. Meta-analysis showed that HR followed by progestogens achieved a higher pooled regression (98.06% vs 77.20% P < 0.0001) and live birth rate (52.57% vs 33.38%, P = 0.0944) and a lower recurrence rate compared with oral progestogens alone (4.79% vs 32.17% P = 0.0004). At the same time, the pooled live birth rate (52.57% vs 18.09% P =0.0399) of HR followed by progestogens are significantly higher than the LNG-IUS alone. Which no statistical difference in regression (98.06% vs 94.24%; P = 0.4098) and recurrence rates (4.79% vs 3.90% P = 0.8561) was seen.ConclusionsOf the available fertility-sparing therapeutic options, HR followed by progestogens may be a more effective one.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Comparison among fertility-sparing therapies for well differentiated early-stage endometrial carcinoma and complex atypical hyperplasia

Zhang

Kanis

et al. 2017

Oncotarget

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“…Increasing the medroxyprogesterone acetate dose to 1000 mg was considered if the patient had 6 to 9 months of persistent disease in follow-up D&Cs. Recurrence was diagnosed if carcinoma was observed on pathology after complete remission 30. An anti-adhesive medication (poloxamer) was used in the endometrial cavity every time D&C was performed 31 32.…”

Section: Methodsmentioning

confidence: 99%

Pregnancy and oncologic outcomes after fertility-sparing management for early stage endometrioid endometrial cancer

Chae

Shim

Lee

et al. 2019

Int J Gynecol Cancer

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ObjectiveHormonal management is an alternative treatment for preserving fertility in patients with presumed early stage endometrioid endometrial cancer. This study aimed to define the pregnancy and oncologic outcomes and factors of successful conception after hormone therapy for endometrioid endometrial cancer.MethodsWe retrospectively analyzed patients presumed to have stage IA, grade 1–2 endometrioid endometrial cancer who underwent fertility-sparing treatment. Concurrent medroxyprogesterone and levonorgestrel-release intra-uterine devices were used for treatment. The pregnancy outcomes and oncologic outcomes were compared between the pregnant and non-pregnant groups.ResultsSeventy-one patients presumed to have stage IA, grade 1–2 endometrioid endometrial cancer had complete remission, and 49 of them tried to conceive. Twenty-two (44.9%) patients became pregnant; the total number of pregnancies was 30. These pregnancies resulted in seven abortions (23.3%), one pre-term birth (3.3%), and 20 full-term births (66.6%). The total live birth rate was 66.6 % (20/30). The median duration of hormonal treatment was 11.9 months (range 4–49) and 12.0 months (range 3–35) in the pregnant and non-pregnant groups, respectively. On multivariate analysis, age, body mass index, treatment duration, medroxyprogesterone dose, and number of dilatation and curettage biopsies were not significantly associated with pregnancy failure, but the association with grade (OR 6.2, 95% CI 1.0 to 38.9; P<0.05) was statistically significant. The median disease-free survival duration was 26 months (range 20–38) and 12 months (range 4–48) in the pregnant and non-pregnant groups, respectively (P<0.05, log-rank test).ConclusionsA lower grade might be a positive factor for future pregnancy. Moreover, successful pregnancy might be a factor in preventing recurrence.

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“…Hysteroscopic resection (HR) was performed using a 5 mm cutting loop electrode to resect (1) the tumor lesion, (2) the endometrium adjacent to the tumor, (3) the myometrium underlying the tumor. The hysteroscopic procedure is further detailed in our previous paper [6]. If final pathology confirmed a G1 endometrioid EC with no myometrial invasion and PR positivity at immunohistochemistry, hormone therapy was started 1 week after HR.…”

Section: Methodsmentioning

confidence: 99%

Fertility preserving treatment with hysteroscopic resection followed by progestin therapy in young women with early endometrial cancer

et al. 2017

Self Cite

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ObjectiveTo report our 15-year institutional experience of fertility-sparing treatment in young patients with early endometrial cancer (EC) treated by combined hysteroscopic resection and progestin therapy.MethodsTwenty-eight patients (stage IA, G1 and 2 endometrioid EC) wishing to preserve their fertility were enrolled into this prospective study. Hysteroscopic resection was used to resect the tumor, endometrium adjacent to the tumor and myometrium underlying the tumor. Adjuvant hormonal therapy consisted of oral megestrol acetate or levonorgestrel intrauterine device for 6 months or more.ResultsAfter 3 months from the progestin start date, 25 patients (89.3%) showed a complete regression (median time to complete regression, 3 months [range, 3-9 months]), two (7.1%) showed persistent disease, while one patient (3.6%) presented with progressive disease and underwent definitive surgery (stage IA, G3 endometrioid). At 6 months, one of the two patients with persistent disease underwent definitive surgery (stage IA, G1 endometrioid), while the other one was successfully re-treated. Two recurrences were observed (7.7%) both involving the endometrium and synchronous ovarian cancer. The median duration of complete response was 94.5 months (range, 8-175 months). More than half of the responders (57.7%) attempted to conceive with 93.3% and 86.6% pregnancy and live birth rates, respectively.ConclusionThe addition of a standardized three-step resectoscopy to progestin would seem to improve the efficacy of progestin alone. High pregnancy and live birth rates were observed in women attempting to conceive.

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Long-Term Oncologic and Reproductive Outcomes in Young Women With Early Endometrial Cancer Conservatively Treated: A Prospective Study and Literature Update

Cited by 55 publications

References 37 publications

Comparison among fertility-sparing therapies for well differentiated early-stage endometrial carcinoma and complex atypical hyperplasia

Comparison among fertility-sparing therapies for well differentiated early-stage endometrial carcinoma and complex atypical hyperplasia

Pregnancy and oncologic outcomes after fertility-sparing management for early stage endometrioid endometrial cancer

Fertility preserving treatment with hysteroscopic resection followed by progestin therapy in young women with early endometrial cancer

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