Regression, relapse, and live birth rates with fertility-sparing therapy for endometrial cancer and atypical complex endometrial hyperplasia: a systematic review and metaanalysis

Gallos, Ioannis D; Yap, Jason; Rajkhowa, Madhurima; Luesley, David; Coomarasamy, Aravinthan; Gupta, Janesh

doi:10.1016/j.ajog.2012.08.011

Cited by 301 publications

(321 citation statements)

References 39 publications

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“…According to the findings reported in previous review articles, the endometrial cancer recurrence rate after successful fertilitysparing therapy ranges between 19.2% and 33.8% [73-75, 78, 82, 89-97]. The most contemporary meta-analysis of these patients reported a pooled recurrence rate of 40.6% (95% confidence interval, 33.1%-49.8%) [98]. In the study of Park et al [14], the recurrence rate after successful progestin therapy was 30.4%, so that the durable complete response rate to progestin therapy was 54.5%.…”

Section: Oncologic Outcomes After Progestin Therapymentioning

confidence: 99%

“…However, recent review articles and previous studies report a mean complete response rate ranging from 66.7% to 79.7% [73-75, 78, 82, 89-97]. The most recent meta-analysis, which included 408 patients from 32 studies published between 1983 and 2011, reported a pooled complete response rate of 76.2% (95% confidence interval, 68%-85.3%) [98]. However, various types of fertilitysparing therapy were included in these review articles, and meta-analysis and the indication for fertility-sparing therapy were not limited to stage IA (confined to endometrium), grade 1 endometrioid endometrial cancer.…”

Section: Oncologic Outcomes After Progestin Therapymentioning

confidence: 99%

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Progestins in the Fertility-Sparing Treatment and Retreatment of Patients With Primary and Recurrent Endometrial Cancer

Nam

2015

The Oncologist

109

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Endometrial cancer is the most common gynecologic cancer in developed countries. Approximately 3%-14% of endometrial cancers are diagnosed in young women under 40 who want to preserve their fertility. The incidence of endometrial cancer in this age group is increasing, for which fertility-sparing therapy is increasingly used because it is one of the most important quality of life issues in these women. Progestin therapy is the most common type of fertility-sparing therapy. In this review, the most up-to-date findings regarding fertility-sparing progestin therapy for young women with primary and recurrent endometrial cancer is addressed in terms of diagnosis, treatment, follow-up, and oncologic and reproductive outcomes. Fertility-sparing progestin therapy is highly effective in selected young women with primary and recurrent endometrial cancer. The selection of appropriate patients through comprehensive pretreatment evaluation is of paramount importance to achieve the best outcomes without compromising survival. Because of the high rate of recurrence after successful fertility-sparing therapy, close surveillance is mandatory, and prophylactic hysterectomy is the best option for patients who have completed family planning. Pregnancy outcomes are very promising with the aid of assisted reproductive technologies. Continuous daily oral medroxyprogesterone acetate and megestrol acetate are the preferred progestins for fertility-sparing therapy, but future studies should be performed to determine the optimal dose and treatment duration of these agents. The Oncologist 2015; 20:270-278 Implications for Practice: In young women with endometrial cancer, the cure rate is very high.Therefore, the efficacy of treatment should not be limited to the oncologic outcomes.The quality-of-life issue is as important as oncologic outcomes in these patients. Fertility preservation is one of the most important quality-of-life issues. Based on the results of numerous studies, fertility-sparing progestin therapy can be safely performed in endometrioid adenocarcinoma confined to the endometrium. It also can be reasonably recommended to selected women with more advanced disease and recurrent disease. However, careful follow-up is important because of the high rate of recurrence.

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Section: Oncologic Outcomes After Progestin Therapymentioning

confidence: 99%

Section: Oncologic Outcomes After Progestin Therapymentioning

confidence: 99%

Progestins in the Fertility-Sparing Treatment and Retreatment of Patients With Primary and Recurrent Endometrial Cancer

Nam

2015

The Oncologist

109

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“…So far, there have been an increasing number of successful deliveries after conservative treatment for EC/ACEH [2][3][4]. We suppose that many patients undergo infertility treatment including assisted reproductive technology (ART), because we speculate most of the patients have ovulation disorders, which could contribute to the occurrence of the disease.…”

Section: Introductionmentioning

confidence: 99%

The outcome of infertility treatment in patients undergoing assisted reproductive technology after conservative therapy for endometrial cancer

Fujimoto

Ichinose

Harada

et al. 2014

J Assist Reprod Genet

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Purpose To elucidate the problems in infertility treatment for women after conservative therapy for endometrial cancer (EC) or atypical complex endometrial hyperplasia (ACEH). Methods The clinical outcomes of 21 patients who underwent assisted reproductive technology after conservative therapy (group A) and 42 control women (group B) were retrospectively analyzed. Results There was no significant difference in the number of retrieved oocytes, fertilization rate or the number of transferred embryos between the two groups. Women in group A had a significantly thinner endometrium and a reduced implantation rate compared to those for women in group B. There was no significant difference in the cumulative clinical pregnancy and delivery rates between group A and B. The patients in group A required significantly more embryos for achieving a live-birth. Conclusions Our results indicate that a thin endometrium after repeated curettage may have a negative effect on endometrial receptivity of patients after conservative treatment for EC/ACEH. Clinicians should reconsider their present protocols and make efforts to minimize the damage to normal endometrium.

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“…An individualised approach is necessary for patients who still wish to fall pregnant. Women must be informed that despite progesterone therapy atypia will persist in 14 % of cases and 3-7% will progress [22,23]. Ultimately a quarter of cases will recur, the most important risk factor being obesity (body mass index ≥ 35 kg/m 2 ) in which case treatment with metformin is recommended [24].…”

Section: Treatment Of Precursor Lesionsmentioning

confidence: 99%

Current Issues in the Diagnosis and Treatment of Endometrial Carcinoma

Stubert¹,

Gerber²

2016

Geburtshilfe Frauenheilkd

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Zielführend für die Diagnose des Endometriumkarzinoms ist in der überwiegenden Zahl der Fäl-Zusammenfassung ! Das Endometriumkarzinom ist das häufigste Karzinom des weiblichen Genitales. Führendes klinisches Zeichen ist die postmenopausale Blutung. Für die Diagnosestellung ist immer eine Endometriumbiopsie notwendig. Die Therapieentscheidung hängt von der Risikoeinschätzung des Karzinoms und der häufig vorliegenden Komorbidität ab. In Fällen mit niedrigem Risiko (Definition: pT1 a, G1/2) ist eine pelvine und paraaortale Lymphknotendissketion unnötig. Eine adjuvante Bestrahlung und eine Systemtherapie sind zumeist vermeidbar. Die Behandlung von Hochrisikopatientinnen (G3 und/oder pT1b) und von Patientinnen in palliativer Situation ist schwierig und weniger gut standardisiert. Neue, molekular definierte Subtypen könnten hier zukünftig Therapieentscheidungen erleichtern.

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Regression, relapse, and live birth rates with fertility-sparing therapy for endometrial cancer and atypical complex endometrial hyperplasia: a systematic review and metaanalysis

Cited by 301 publications

References 39 publications

Progestins in the Fertility-Sparing Treatment and Retreatment of Patients With Primary and Recurrent Endometrial Cancer

Progestins in the Fertility-Sparing Treatment and Retreatment of Patients With Primary and Recurrent Endometrial Cancer

The outcome of infertility treatment in patients undergoing assisted reproductive technology after conservative therapy for endometrial cancer

Current Issues in the Diagnosis and Treatment of Endometrial Carcinoma

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