Treatment efficiency of comprehensive hysteroscopic evaluation and lesion resection combined with progestin therapy in young women with endometrial atypical hyperplasia and endometrial cancer

Yang, Bingyi; Xu, Yi; Zhu, Qin; Xie, Liying; Shan, Weiwei; Ning, Chengcheng; Xie, Bin; Shi, Yue; Luo, Xuezhen; Zhang, Hongwei; Chen, Xiaojun

doi:10.1016/j.ygyno.2019.01.014

Cited by 78 publications

(60 citation statements)

References 30 publications

(38 reference statements)

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“…Pregnancy rates in these studies among those who attempted conception, including through assisted reproductive technology (ART), ranged from 25% to 66%, suggesting the potential for superior outcomes compared to hormone treatment alone. Recent studies have confirmed these findings, reporting complete response rates in women with stage 1A EC of 89% to 97% following hysteroscopic fertility-sparing treatment, and pregnancy rates of over 45% among women who attempted conception [ 78 , 79 ]. Concerns have been raised about possible negative consequences of hysteroscopy due to EC cells spreading into the peritoneal cavity and the likelihood of adverse pregnancy outcomes due to mechanical damage to the basal layer of the endometrium causing Asherman’s syndrome and a risk of placenta accreta [ 80 ].…”

Section: Fertility-sparing Managementmentioning

confidence: 86%

Fertility-sparing treatment in early endometrial cancer: current state and future strategies

et al. 2020

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Endometrial cancer (EC) is the fifth most common cancer in women worldwide. Global estimates show rising incidence rates in both developed and developing countries. Most women are diagnosed postmenopausal, but 14–25% of patients are premenopausal and 5% are under 40 years of age. Established risk factors include age and hyperestrogenic status associated with nulliparity, obesity, and metabolic syndrome. Standard treatment for EC, which involves total hysterectomy and bilateral salpingo-oophorectomy, has excellent survival outcomes, particularly for low-grade endometrioid tumors. However, it leads to permanent loss of fertility among women who wish to preserve their reproductive potential. With current trends of reproductive-age women delaying childbearing, rising EC incidence rates, and a growing epidemic of obesity, particularly in developed countries, research on conservative non-surgical treatment approaches remains a top priority. Fertility-sparing treatment predominantly involves the use of oral progestins and levonorgestrel-releasing intrauterine devices, which have been shown to be feasible and safe in women with early stage EC and minimal or no myometrial invasion. However, data on the efficacy and safety of conservative management strategies are primarily based on retrospective studies. Randomized clinical trials in younger women and high-risk obese patients are currently underway. Here, we have presented a comprehensive review of the current literature on conservative, fertility-sparing approaches, defining the optimal candidates and evaluating tumor characteristics, reproductive and oncologic outcomes, and ongoing clinical trials. We have also summarized current guidelines and recommendations based on the published literature.

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Section: Fertility-sparing Managementmentioning

confidence: 86%

Fertility-sparing treatment in early endometrial cancer: current state and future strategies

et al. 2020

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“…Yang et al . reported a large number of cases of comprehensive hysteroscopic evaluation and lesion resections combined with progestin therapy in young women with AEH and EC . Women with EC treated by hysteroscopic resectioning combined with progestin therapy had a regression, recurrence and pregnancy rate of 97.3%, 11.1% and 37.5%, respectively.…”

Section: Current Methods Used In Fertility‐sparing Treatment Of Endommentioning

confidence: 99%

New therapeutic approaches for the fertility‐sparing treatment of endometrial cancer

Mitsuhashi

Shozu

2020

J of Obstet and Gynaecol

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This review seeks to describe new fertility-sparing endometrial cancer (EC) treatment strategies that take into consideration the medical and general health background of patients. We particularly focus on the application of metformin, which is a biguanide widely prescribed for treatment of type 2 diabetes mellitus. Fertilitysparing treatment using progestin is considered a standard treatment option for patients with atypical endometrial hyperplasia (AEH) and EC who desire to conceive. A previous meta-analysis of fertility-sparing treatments revealed a high remission rate; however, high rates of relapse persisted. Most young patients with AEH and EC who are subjected to fertility-sparing treatment have a background of obesity, insulin resistance and abnormal glucose tolerance complicated with polycystic ovary syndrome. Recently, metformin has been attracting more attention in the field of cancer research. Several in vitro and in vivo reports regarding the efficacy of metformin in EC management have accumulated. Thus far, the efficacy of combining metformin with progestin has been revealed in a single phase II study of medroxyprogesterone acetate in combination with metformin as a fertility-sparing treatment for patients with AEH or EC. In addition to improving the metabolic profile of patients with EC having metabolic disorders, metformin supplementation may improve the long-term oncological outcome of these patients. To date, many clinical trials employing progestin and metformin as a fertility-sparing treatment of AEH and EC are ongoing. In the near future, it is expected that the clinical advantage of metformin progestin combination therapy will be clarified.

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“…Work-up for fertility preservation treatments Fertility-sparing treatments should be considered in patients with atypical hyperplasia/endometrioid intraepithelial neoplasia (AH/EIN) or grade 1 endometrioid carcinoma without myometrial invasion [262][263][264][265][266][267][268]. There are very few published data on patients with stage IA grade 2 endometrioid carcinoma without myometrial invasion who received fertility sparing treatment with combined oral medroxyprogesterone acetate/levonorgestrel intrauterine system [269].…”

Section: Fertility Preservationmentioning

confidence: 99%

“…So far, there are no available randomized controlled trials comparing different methods of conservative treatment in women with AH/EIN or presumed stage IA grade 1 endometrioid carcinoma. Existing data suggest that patients who received hysteroscopic resection followed by progestin therapy achieve the highest complete remission rate as compared with other existing fertilitypreserving treatments [262][263][264][265][266][267][268][277][278][279][280][281][282][283][284][285][286][287][288][289][290][291][292][293][294]. Intrauterine progestin therapy such as levonorgestrel-releasing intrauterine system combined with gonadotropin-release hormone receptor agonist/progestin have a satisfactory pregnancy rate and low recurrence rate.…”

Section: Management and Follow-up For Fertility Preservationmentioning

confidence: 99%

ESGO/ESTRO/ESP guidelines for the management of patients with endometrial carcinoma

Concin

Matías‐Guiu

Vergote

et al. 2021

Radiotherapy and Oncology

169

203

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A European consensus conference on endometrial carcinoma was held in 2014 to produce multidisciplinary evidence-based guidelines on selected questions. Given the large body of literature on the management of endometrial carcinoma published since 2014, the European Society of Gynaecological Oncology (ESGO), the European SocieTy for Radiotherapy & Oncology (ESTRO) and the European Society of Pathology (ESP) jointly decided to update these evidence-based guidelines and to cover new topics in order to improve the quality of care for women with endometrial carcinoma across Europe and worldwide. ESGO/ESTRO/ESP nominated an international multidisciplinary development group consisting of practicing clinicians and researchers who have demonstrated leadership and expertise in the care and research of endometrial carcinoma (27 experts across Europe). To ensure that the guidelines are evidence-based, the literature published since 2014, identified from a systematic search was reviewed and critically appraised. In the absence of any clear scientific evidence, judgment was based on the

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Treatment efficiency of comprehensive hysteroscopic evaluation and lesion resection combined with progestin therapy in young women with endometrial atypical hyperplasia and endometrial cancer

Cited by 78 publications

References 30 publications

Fertility-sparing treatment in early endometrial cancer: current state and future strategies

Fertility-sparing treatment in early endometrial cancer: current state and future strategies

New therapeutic approaches for the fertility‐sparing treatment of endometrial cancer

ESGO/ESTRO/ESP guidelines for the management of patients with endometrial carcinoma

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