Survival after stage IA endometrial cancer; can follow‐up be altered? A prospective nationwide Danish survey

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.

Section: Introductionmentioning

confidence: 99%

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

Chae

Shim

Lee

et al. 2019

“…4 However, for these young women, the standard management is immensely affecting their quality of life as their chance of childbearing is lost. For this specific population, more conservative approaches using mainly medical treatment with high-dose oral progestins, that is, medroxyprogesterone acetate (MPA), megestrol acetate (MA), and more recently with levonorgestrel-release intrauterine devices (LNG-IUDs) have been reported.…”

mentioning

confidence: 99%

European Society of Gynecological Oncology Task Force for Fertility Preservation: Clinical Recommendations for Fertility-Sparing Management in Young Endometrial Cancer Patients

Rodolakis

Biliatis

Morice

et al. 2015

150

171

Endometrial cancer (EC) in young women of reproductive age is a relatively rare diagnosis. However, since in the modern era women delay their childbearing for a variety of social reasons, more and more women in the near future will be nulliparous and have a diagnosis of EC at the same time. Hence, a more conservative approach of EC is desirable to preserve fertility of these women, without compromising their survival. Recently, the number of studies reporting encouraging results on fertility-sparing management of EC with high dose of progestins is increasing. It seems that preserving the uterus and the ovaries in a carefully selected patient with EC confers only a very small risk combined with an enormous benefit. Selection of women suitable for such a conservative approach, as well as method of treatment, follow-up, recurrence, obstetric outcomes, and survival rates are very important parameters when consulting women with EC wishing to preserve their fertility. In this article, we try to elucidate all the previously mentioned aspects and formulate clinical recommendations, based on published data, about the most proper approach and consultation of these patients.

“…Patients were enrolled if they met the following criteria: (1) aged 18 to 40 years; (2) pathological diagnosis of welldifferentiated (G1) endometrioid EC with progesterone receptors (PR) at 50% or greater positivity at immunohistochemistry; (3) no radiologic (transvaginal ultrasonography [TVS]; abdomenpelvis magnetic resonance [MR]; chest x-ray) evidence of myometrial/cervical invasion, retroperitoneal lymph node involvement, ovarian tumors, and/or distant metastasis; (4) normal (G35 IU/mL) CA125 serum levels; (5) no contraindication for progestin treatment; (6) strong desire to preserve fertility; and (7) written acceptance of an informed consent including availability for completing the follow-up program and definitive surgery after complete childbearing.…”

Section: Methodsmentioning

confidence: 99%

“…2 Young women are usually diagnosed with low-grade, early-stage disease, and have excellent prognosis with 5-year and 10-year disease-free survival of up to 99.2% and 98%, respectively. 3,4 The standard treatment for EC consists of hysterectomy, bilateral salpingooophorectomy, and eventually pelvic and aortic lymphadenectomy. This treatment precludes future fertility and may thus be undesirable to women wishing to maintain their reproductive potential.…”

mentioning

confidence: 99%

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

Laurelli¹,

Falcone²,

Gallo³

et al. 2016