International Journal of Clinical Oncology

, Volume 24, Issue 6, pp 712–720 | Cite as

Prolonged conservative treatment in patients with recurrent endometrial cancer after primary fertility-sparing therapy: 15-year experience

  • Yao Wang
  • Mei YuEmail author
  • Jia-xin Yang
  • Dong-yan Cao
  • Zhen Yuan
  • Hui-mei Zhou
  • Ying Zhang
  • Lei Li
  • Keng Shen
  • Huanwen Wu
Original Article



To evaluate the efficacy and prognosis of repeated treatment on patients with recurrent endometrial cancer (EC) after complete remission for primary fertility-preserving therapy.

Materials and methods

We performed a retrospective study of patients with presumed stage IA endometrial cancer who had recurrence after achieving complete remission by fertility-preserving management at the Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, from January 2003 to April 2018. For each patient, medical records and pathology reports were reviewed. The demographic features, treatment efficacy, tumor prognosis, and reproductive outcome were analyzed.


Of the 41 recurrent patients with a median disease-free interval period of 16 months (range, 5–55 months), 23 were diagnosed at recurrence as EC, and 18 were diagnosed as atypical hyperplasia (AH) or endometrial intraepithelial neoplasia (EIN). 26 patients received repeated fertility-preserving treatment, and 23 patients were evaluable for efficacy. The complete response (CR) rate of repeated treatment (19/23, 82.6%) was lower than that of primary fertility-preserving treatment (161/170, 94.7%) with borderline significance (P = 0.053). The CR rate of AH/EIN patients was higher than that of EC patients with no statistical difference (92.9% vs 66.7%, P = 0.260). Among 19 patients achieved CR, 3 got pregnant and delivered successfully, while 3 had a second relapse. Four cases failed to response to the repeated treatment and underwent definitive surgery. 15 patients referred to definitive surgery directly after recurrence and one of them had a pelvic recurrence after 120 months. All patients are alive without evidence of disease at last follow-up.


For patients with recurrent EC after primary fertility-preserving treatment, repeated fertility-preserving treatment can still achieve a promising response and patients have possibilities of completing childbirth.


Endometrial cancer Recurrence Fertility-preserving therapy Oncofertility 



The authors thank all of the faculty, nurses, and staff at Department of Obstetrics &Gynecology in Peking Union Medical College Hospital for the excellent care they provide patients. The authors also sincerely thank all the patients and their family members for their contribution to this research effort.


This work was supported by the Chinese Academy of Medical Sciences Initiative for Innovative Medicine (CAMS-2017-I2M-1-002).

Compliance with ethical standards

Conflict of interest

The authors declare that there are no conflicts of interest.

Supplementary material

10147_2019_1404_MOESM1_ESM.docx (24 kb)
Supplementary material 1 (DOCX 24 KB)


  1. 1.
    Jemal A, Bray F, Center MM et al (2011) Global cancer statistics. CA Cancer J Clin 61(2):69–90CrossRefGoogle Scholar
  2. 2.
    Chen W, Zheng R, Baade PD et al (2016) Cancer statistics in China, 2015. CA Cancer J Clin 66(2):115–132CrossRefGoogle Scholar
  3. 3.
    Rackow BW, Arici A (2006) Endometrial cancer and fertility. Curr Opin Obstet Gynecol 18(3):245–252CrossRefGoogle Scholar
  4. 4.
    Corzo C, Santillan NB, Westin SN et al (2018) Updates on conservative management of endometrial cancer. J Minim Invasive Gynecol 25(2):308–313CrossRefGoogle Scholar
  5. 5.
    Kim YB, Holschneider CH, Ghosh K et al (1997) Progestin alone as primary treatment of endometrial carcinoma in premenopausal women. Report of seven cases and review of the literature. Cancer 79(2):320–327CrossRefGoogle Scholar
  6. 6.
    Ramirez PT, Frumovitz M, Bodurka DC et al (2004) Hormonal therapy for the management of grade 1 endometrial adenocarcinoma: a literature review. Gynecol Oncol 95(1):133–138CrossRefGoogle Scholar
  7. 7.
    Gallos ID, Yap J, Rajkhowa M et al (2012) Regression, relapse, and live birth rates with fertility-sparing therapy for endometrial cancer and atypical complex endometrial hyperplasia: a systematic review and metaanalysis. Am J Obstet Gynecol 207(4):266 e261–e212CrossRefGoogle Scholar
  8. 8.
    Baek JS, Lee WH, Kang WD et al (2016) Fertility-preserving treatment in complex atypical hyperplasia and early endometrial cancer in young women with oral progestin: is it effective? Obstet Gynecol Sci 59(1):24–31CrossRefGoogle Scholar
  9. 9.
    Pronin SM, Novikova OV, Andreeva JY et al (2015) Fertility-sparing treatment of early endometrial cancer and complex atypical hyperplasia in young women of childbearing potential. Int J Gynecol Cancer 25(6):1010–1014CrossRefGoogle Scholar
  10. 10.
    Zhou H, Cao D, Yang J et al (2017) Gonadotropin-releasing hormone agonist combined with a levonorgestrel-releasing intrauterine system or letrozole for fertility-preserving treatment of endometrial carcinoma and complex atypical hyperplasia in young women. Int J Gynecol Cancer 27(6):1178–1182CrossRefGoogle Scholar
  11. 11.
    Koskas M, Uzan J, Luton D et al (2014) Prognostic factors of oncologic and reproductive outcomes in fertility-sparing management of endometrial atypical hyperplasia and adenocarcinoma: systematic review and meta-analysis. Fertil Steril 101(3):785–794CrossRefGoogle Scholar
  12. 12.
    Park JY, Lee SH, Seong SJ et al (2013) Progestin re-treatment in patients with recurrent endometrial adenocarcinoma after successful fertility-sparing management using progestin. Gynecol Oncol 129(1):7–11CrossRefGoogle Scholar
  13. 13.
    Yamagami W, Susumu N, Makabe T et al (2018) Is repeated high-dose medroxyprogesterone acetate (MPA) therapy permissible for patients with early stage endometrial cancer or atypical endometrial hyperplasia who desire preserving fertility? J Gynecol Oncol 29(2):e21CrossRefGoogle Scholar
  14. 14.
    Yu M, Yang JX, Wu M et al (2009) Fertility-preserving treatment in young women with well-differentiated endometrial carcinoma and severe atypical hyperplasia of endometrium. Fertil Steril 92(6):2122–2124CrossRefGoogle Scholar
  15. 15.
    Scully RE, Young RH, Clement PB (1998) Tumors of the ovary, maldeveloped gonads, fallopian tube, and broad ligament, Atlas of Tumor Pathology. Armed Forces Institute of Pathology, BethesdaGoogle Scholar
  16. 16.
    Perri T, Korach J, Gotlieb WH et al (2011) Prolonged conservative treatment of endometrial cancer patients: more than 1 pregnancy can be achieved. Int J Gynecol Cancer 21(1):72–78CrossRefGoogle Scholar
  17. 17.
    Qin Y, Yu Z, Yang J et al (2016) Oral progestin treatment for early-stage endometrial cancer: a systematic review and meta-analysis. Int J Gynecol Cancer 26(6):1081–1091CrossRefGoogle Scholar
  18. 18.
    Baker J, Obermair A, Gebski V et al (2012) Efficacy of oral or intrauterine device-delivered progestin in patients with complex endometrial hyperplasia with atypia or early endometrial adenocarcinoma: a meta-analysis and systematic review of the literature. Gynecol Oncol 125(1):263–270CrossRefGoogle Scholar
  19. 19.
    Kim MK, Yoon BS, Park H et al (2011) Conservative treatment with medroxyprogesterone acetate plus levonorgestrel intrauterine system for early-stage endometrial cancer in young women: pilot study. Int J Gynecol Cancer 21(4):673–677Google Scholar
  20. 20.
    Ushijima K, Yahata H, Yoshikawa H et al (2007) Multicenter phase II study of fertility-sparing treatment with medroxyprogesterone acetate for endometrial carcinoma and atypical hyperplasia in young women. J Clin Oncol 25(19):2798–2803CrossRefGoogle Scholar
  21. 21.
    Eftekhar Z, Izadi-Mood N, Yarandi F et al (2009) Efficacy of megestrol acetate (megace) in the treatment of patients with early endometrial adenocarcinoma: our experiences with 21 patients. Int J Gynecol Cancer 19(2):249–252CrossRefGoogle Scholar
  22. 22.
    Parkash V, Fadare O, Tornos C et al (2015) Committee opinion no. 631: endometrial intraepithelial neoplasia. Obstet Gynecol 126(4):897CrossRefGoogle Scholar
  23. 23.
    Signorelli M, Caspani G, Bonazzi C et al (2009) Fertility-sparing treatment in young women with endometrial cancer or atypical complex hyperplasia: a prospective single-institution experience of 21 cases. BJOG 116(1):114–118CrossRefGoogle Scholar
  24. 24.
    Yamazawa K, Hirai M, Fujito A et al (2007) Fertility-preserving treatment with progestin, and pathological criteria to predict responses, in young women with endometrial cancer. Hum Reprod 22(7):1953–1958CrossRefGoogle Scholar
  25. 25.
    Navarria I, Usel M, Rapiti E et al (2009) Young patients with endometrial cancer: how many could be eligible for fertility-sparing treatment? Gynecol Oncol 114(3):448–451CrossRefGoogle Scholar
  26. 26.
    Hurst SA, Hartzfeld KM, Del Priore G (2008) Occult myometrial recurrence after progesterone therapy to preserve fertility in a young patient with endometrial cancer. Fertil Steril 89(3):724.e721–724.e723CrossRefGoogle Scholar
  27. 27.
    Gonthier C, Trefoux-Bourdet A, Koskas M (2017) Impact of conservative managements in young women with grade 2 or 3 endometrial adenocarcinoma confined to the endometrium. Int J Gynecol Cancer 27(3):493–499CrossRefGoogle Scholar
  28. 28.
    Lu KH, Schorge JO, Rodabaugh KJ et al (2007) Prospective determination of prevalence of lynch syndrome in young women with endometrial cancer. J Clin Oncol 25(33):5158–5164CrossRefGoogle Scholar
  29. 29.
    Kohlmann W, Gruber SB (2012) Lynch syndrome. In: Pagon RA, Adam MP, Ardinger HH et al (eds) GeneReviews. University of Washington, SeattleGoogle Scholar

Copyright information

© Japan Society of Clinical Oncology 2019

Authors and Affiliations

  1. 1.Department of Obstetrics and Gynecology, Peking Union Medical College HospitalChinese Academy of Medical Science and Peking Union Medical CollegeBeijingChina
  2. 2.Department of Pathology, Peking Union Medical College HospitalChinese Academy of Medical Science and Peking Union Medical CollegeBeijingChina

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