Management of Recurrent Endometrial Cancer or Atypical Endometrial Hyperplasia Patients After Primary Fertility-Sparing Therapy

Chen, Junyu; Cao, Dongyan; Yang, Jiaxin; Yu, Mei; Zhou, Huixuan; Cheng, Ninghai; Wang, Jinhui; Zhang, Ying; Peng, Peng; Shen, Keng

doi:10.3389/fonc.2021.738370

Cited by 12 publications

(21 citation statements)

References 44 publications

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“…In our previous study, the CR rate was about 90% in BMI normal patients. However, with increased treatment times, the recurrence time shortened, and no patients got pregnant after the third-round treatment (12). Patients were supposed to be informed of treatment failure and conceive before the retreatment.…”

Section: Discussionmentioning

confidence: 99%

“…The treatment protocol was described in our previous work (12). Two regimens were used: (1) Progestin therapy: oral medroxyprogesterone acetate (MPA) 500 mg daily or megestrol acetate (MA) 160 mg bid; (2) gonadotropin-releasing hormone agonist (GnRHa)-based therapy: a combination of subcutaneous 3.75 mg GnRHa injection every 4 weeks and levonorgestrelreleasing intrauterine system (LNG-IUS) (Mirena) insertion constantly or oral letrozole 2.5 mg daily.…”

Section: Treatment Methodsmentioning

confidence: 99%

“…The treatment outcomes were categorized as complete response (CR), partial response (PR), stable disease (SD), and progressive disease (PD), as illustrated in our previous work (12). CR was defined as the absence of disease.…”

Section: Response Evaluationmentioning

confidence: 99%

“…The follow-up schedule was the same as reported in our previous article (12). All patients were regularly followed up for a prolonged period with 3-to 6-month intervals.…”

Section: Follow-upmentioning

confidence: 99%

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

Chen¹,

Cao²,

Yang³

et al. 2022

Front. Oncol.

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Treatment Methodsmentioning

confidence: 99%

Section: Response Evaluationmentioning

confidence: 99%

“…The follow-up schedule was the same as reported in our previous article (12). All patients were regularly followed up for a prolonged period with 3-to 6-month intervals.…”

Section: Follow-upmentioning

confidence: 99%

See 2 more Smart Citations

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

Chen¹,

Cao²,

Yang³

et al. 2022

Front. Oncol.

Self Cite

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“…EC incidence is increasing all over the world, especially in developing countries [ 68 , 69 , 70 ]. According to the United Kingdom statistics, it has increased by 50% in recent decades [ 69 ].…”

Section: Management Of Endometrial Cancermentioning

confidence: 99%

Contemporary Fertility-Sparing Management Options of Early Stage Endometrioid Endometrial Cancer in Young Nulliparous Patients

Aimagambetova

Terzić

Laganà

et al. 2021

JCM

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Incidence of endometrial cancer (EC) has been increasing in recent years, especially in high-income countries. The disease commonly affects peri- and postmenopausal women; however, about 5% of women are diagnosed with EC in their reproductive age. Due to both the increasing incidence of EC among reproductive age women and trends to delayed childbearing, fertility-sparing treatment for young patients with EC has become extremely important for researchers and practitioners. Because the classic treatment with total hysterectomy and bilateral saplingo-oophorectomy is not an appropriate approach for young women demanding fertility preservation, several fertility-sparing options have been developed and summarized in this review. Utilization of different medications and their combination (progestagens, gonadotropin releasing hormones analogues, and metformin in different formulations) are tested and found as efficient for fertility-sparing treatment. New minimally invasive surgical techniques, combined with progestagens, are also confirmed as valuable. There are many novel conservative and surgical treatment approaches under investigation. Assuming that molecular biomarkers can be both diagnostic and prognostic to assist in prediction of response to a certain therapy, prognostic risk groups’ stratification along with specific biomarkers’ identification will ensure low recurrence and decrease mortality rates in young women with EC.

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Conservative re‐treatment of women with atypical endometrial hyperplasia and early endometrial carcinoma: We can hope, at least

Raffone,

Raimondo,

Rovero

et al. 2023

Intl J Gynecology & Obste

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BackgroundIn women with recurrent disease who were conservatively treated for atypical endometrial hyperplasia (AEH) and early endometrial carcinoma (EEC), the reasons why conservative treatment was chosen persist and outcomes of performing a conservative re‐treatment are unclear, as pooled estimates on oncologic outcomes of such a re‐treatment are lacking.ObjectivesTo provide pooled estimates of oncologic outcomes of conservative re‐treatment in women with recurrent AEH or EC.Search StrategyA systematic review and meta‐analysis was performed by searching six electronic databases from their inception to March 2022.Selection CriteriaStudies that allowed extraction of data about oncologic outcomes of conservative re‐treatment of women with recurrent AEH and EEC after a conservative treatment.Data Collection and AnalysisPooled prevalence of complete response (CR), poor response (PR), and recurrence after conservative re‐treatment was calculated.Main ResultsFifteen studies (12 retrospective and 3 prospective) with 492 women (42.1% AEH and 57.9% EEC) were included in the systematic review, and 10 studies (8 retrospective and 2 prospective) were suitable for the meta‐analysis. Pooled prevalence was 85.3% (95% confidence interval [CI] 77.0%–91.0%) for CR, 14.7% (95% CI 9.0%–23.0%) for PR, and 40.4% (95% CI 15.5%–71.4%) for recurrence.ConclusionsConservative re‐treatment in AEH or EC recurrent women has a high CR rate and acceptable recurrence rate that might allow it to be considered a safe and viable option, at least as a first round of conservative treatment. Women with an unsatisfied desire for motherhood or with high surgical risk might avoid hysterectomy and attempt childbearing or spare high‐risk surgery.

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Management of Recurrent Endometrial Cancer or Atypical Endometrial Hyperplasia Patients After Primary Fertility-Sparing Therapy

Cited by 12 publications

References 44 publications

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

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

Contemporary Fertility-Sparing Management Options of Early Stage Endometrioid Endometrial Cancer in Young Nulliparous Patients

Conservative re‐treatment of women with atypical endometrial hyperplasia and early endometrial carcinoma: We can hope, at least

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