Fertility-Sparing Treatment Options in Young Patients with Early-Stage Endometrial Cancer
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Purpose of Review
To summarize fertility-sparing treatment options in young patients with early-stage endometrial cancer.
A levonorgestrel-releasing intrauterine device combined with oral progestins seems more effective for patients with endometrial cancer and desiring fertility. Assisted reproductive techniques seem more effective in achieving pregnancy in these young cancer patients than natural conception.
Endometrial cancer is the most common gynecologic cancer in developed countries. For younger patients who wish to have children, fertility preservation methods are available, but not always reasonable in an individual patient. Furthermore, fertility-preserving treatment has some risks with regard to surgical effectivity. The main criteria for fertility-sparing treatment are reproductive age of the patient, fertility desire, a grade 1 well-differentiated tumor, diagnosis should be performed through D&C, stage 1A tumor with no evidence of myometrial invasion on MRI, and no suspicious adnexal mass. A levonorgestrel-releasing intrauterine device combined with oral progestins seems more effective than using oral progestins alone. D&C should be performed every 3 months after the start of progestin therapy. Patients with two negative endometrial D&C results are considered to have a complete response and eligible for pregnancy. Hysteroscopic resection can be used in patients with grade 1 stage 1 endometrial carcinoma who did not respond to progestin treatment.
KeywordsAssisted reproductive techniques Endometrial carcinoma Fertility agents, female, hormonal Hysteroscopic surgery Ovarian cancer
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
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- 7.Gallos ID, Yap J, Rajkhowa M, Luesley DM, Coomarasamy A, Gupta JK. Regression, relapse, and live birth rates with fertility-sparing therapy for endometrial cancer and atypical complex endometrial hyperplasia: a systematic review and metaanalysis. American journal of obstetrics and gynecology. 2012;207(4):266. e1-. e12.CrossRefGoogle Scholar
- 23.Thigpen JT, Brady MF, Alvarez RD, Adelson MD, Homesley HD, Manetta A et al. Oral medroxyprogesterone acetate in the treatment of advanced or recurrent endometrial carcinoma: a dose-response study by the Gynecologic Oncology Group. Journal of Clinical Oncology. 1999;17(6):1736-.PubMedCrossRefPubMedCentralGoogle Scholar
- 24.Ushijima K, Yahata H, Yoshikawa H, Konishi I, Yasugi T, Saito T, et al. Multicenter phase II study of fertility-sparing treatment with medroxyprogesterone acetate for endometrial carcinoma and atypical hyperplasia in young women. J Clin Oncol. 2007;25(19):2798–803.PubMedCrossRefPubMedCentralGoogle Scholar
- 25.Kaku T, Yoshikawa H, Tsuda H, Sakamoto A, Fukunaga M, Kuwabara Y, et al. Conservative therapy for adenocarcinoma and atypical endometrial hyperplasia of the endometrium in young women: central pathologic review and treatment outcome. Cancer Lett. 2001;167(1):39–48.PubMedCrossRefPubMedCentralGoogle Scholar
- 28.Koskas M, Uzan J, Luton D, Rouzier R, Daraï E. Prognostic factors of oncologic and reproductive outcomes in fertility-sparing management of endometrial atypical hyperplasia and adenocarcinoma: systematic review and meta-analysis. Fertility and sterility. 2014;101(3):785–94. e3.CrossRefGoogle Scholar
- 33.• Gallos ID, Krishan P, Shehmar M, Ganesan R, Gupta JK. LNG-IUS versus oral progestogen treatment for endometrial hyperplasia: a long-term comparative cohort study. Human Reproduction. 2013;28(11):2966–71.This study shows the superiority of levonorgestrel-releasing intrauterine device than oral progestins. PubMedCrossRefPubMedCentralGoogle Scholar
- 34.Baker J, Obermair A, Gebski V, Janda M. 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. 2012;125(1):263–70.PubMedCrossRefPubMedCentralGoogle Scholar
- 37.Kim MK, Seong SJ, Song T, Kim M-L, Yoon BS, Jun HS, et al. Comparison of dilatation & curettage and endometrial aspiration biopsy accuracy in patients treated with high-dose oral progestin plus levonorgestrel intrauterine system for early-stage endometrial cancer. Gynecol Oncol. 2013;130(3):470–3.PubMedCrossRefPubMedCentralGoogle Scholar
- 45.•• Zapardiel I, Cruz M, Diestro MD, Requena A, Garcia-Velasco JA. Assisted reproductive techniques after fertility-sparing treatments in gynaecological cancers. Human reproduction update. 2016;22(3):281–305. This study evaluates the effectivity of assisted reproductive techniques and compares the treatment options for gynecological cancers including endometrial cancer. PubMedCrossRefPubMedCentralGoogle Scholar