Fertility sparing surgery for stage IA type I and G2 endometrial cancer in reproductive-aged patients: evidence-based approach and future perspectives

2017 ◽  
Vol 69 (1) ◽  
pp. 29-34 ◽  
Author(s):  
Salvatore Giovanni Vitale ◽  
Diego Rossetti ◽  
Alessandro Tropea ◽  
Antonio Biondi ◽  
Antonio Simone Laganà
Keyword(s):  
Endometrial Cancer ◽  
Evidence Based ◽  
Type I ◽  
Future Perspectives ◽  
Aged Patients ◽  
Fertility Sparing Surgery ◽  
Fertility Sparing ◽  
Stage Ia

Controversies in the management of early endometrial carcinoma: an update

2017 ◽  
Vol 6 (6) ◽  
pp. 2124 ◽  
Author(s):  
P. Reddi Rani ◽  
Jasmina Begum ◽  
K. Sathyanarayana Reddy
Keyword(s):  
Developing Countries ◽  
Endometrial Carcinoma ◽  
Young Women ◽  
Genital Tract ◽  
Best Practice ◽  
Management Strategies ◽  
Evidence Based ◽  
Fertility Sparing Surgery ◽  
Fertility Sparing ◽  
Cure Rates

Endometrial carcinoma (EC) is the commonest genital tract malignancy in developing countries and is usually confined to the uterus at the time of diagnosis with excellent prognosis and high cure rates. But the management is associated with lot of controversies like in staging, best surgical approach, extent of lymphadenectomy, adjuvant therapy, fertility sparing surgery in young women etc. A thorough surgical staging is important to determine uterine and extrauterine spread and also understanding of the pathophysiology and management strategies to identify women who are at high risk and tailoring the adjuvant treatment if necessary without increasing the morbidity. This evidence based narrative review conducted by searching Medline (1994- 2015) and other online articles from Pubmed, Google scholar. Articles were selected based on their currency and relevance to the discussion they summarize the current literature to provide an approach to best practice management of early endometrial carcinoma.

Outcomes of Fertility-Sparing Surgery for Stage I Epithelial Ovarian Cancer: A Proposal for Patient Selection

2010 ◽  
Vol 28 (10) ◽  
pp. 1727-1732 ◽  
Author(s):  
Toyomi Satoh ◽  
Masayuki Hatae ◽  
Yoh Watanabe ◽  
Nobuo Yaegashi ◽  
Osamu Ishiko ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Epithelial Ovarian Cancer ◽  
Clear Cell ◽  
Stage I ◽  
Healthy Children ◽  
Favorable Histology ◽  
Fertility Sparing Surgery ◽  
Fertility Sparing ◽  
Stage Ia ◽  
Grade 3

Purpose The objective of this study was to assess clinical outcomes and fertility in patients treated conservatively for unilateral stage I invasive epithelial ovarian cancer (EOC). Patients and Methods A multi-institutional retrospective investigation was undertaken to identify patients with unilateral stage I EOC treated with fertility-sparing surgery. Favorable histology was defined as grade 1 or grade 2 adenocarcinoma, excluding clear cell histology. Results A total of 211 patients (stage IA, n = 126; stage IC, n = 85) were identified from 30 institutions. Median duration of follow-up was 78 months. Five-year overall survival and recurrence-free survival were 100% and 97.8% for stage IA and favorable histology (n = 108), 100% and 100% for stage IA and clear cell histology (n = 15), 100% and 33.3% for stage IA and grade 3 (n = 3), 96.9% and 92.1% for stage IC and favorable histology (n = 67), 93.3% and 66.0% for stage IC and clear cell histology (n = 15), and 66.7% and 66.7% for stage IC and grade 3 (n = 3). Forty-five (53.6%) of 84 patients who were nulliparous at fertility-sparing surgery and married at the time of investigation gave birth to 56 healthy children. Conclusion Our data confirm that fertility-sparing surgery is a safe treatment for stage IA patients with favorable histology and suggest that stage IA patients with clear cell histology and stage IC patients with favorable histology can be candidates for fertility-sparing surgery followed by adjuvant chemotherapy.

Combined Oral Medroxyprogesterone/Levonorgestrel-Intrauterine System Treatment for Women With Grade 2 Stage IA Endometrial Cancer

2017 ◽  
Vol 27 (4) ◽  
pp. 738-742 ◽  
Author(s):  
Ji Young Hwang ◽  
Da Hee Kim ◽  
Hyo Sook Bae ◽  
Mi-La Kim ◽  
Yong Wook Jung ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Progressive Disease ◽  
Medical Center ◽  
Endometrial Adenocarcinoma ◽  
Complete Response ◽  
Dilatation And Curettage ◽  
Fertility Sparing ◽  
Stage Ia ◽  
The Mean

ObjectiveThe aim of this study was to evaluate the oncologic and pregnancy outcomes of combined oral medroxyprogesterone acetate (MPA)/levonorgestrel-intrauterine system (LNG-IUS) treatment in young women with grade 2–differentiated stage IA endometrial adenocarcinoma who wish to preserve fertility.MethodsWe retrospectively reviewed the medical records of patients with grade 2 stage IA endometrial adenocarcinoma who had received fertility-sparing treatment at CHA Gangnam Medical Center between 2011 and 2015. All of the patients were treated with combined oral MPA (500 mg/d)/LNG-IUS, and follow-up dilatation and curettage were performed every 3 months.ResultsA total of 5 patients were included in the study. The mean age was 30.4 ± 5.3 years (range, 25–39 years). After a mean treatment duration of 11.0 ± 6.2 months (range, 6–18 months), complete response (CR) was shown in 3 of the 5 patients, with partial response (PR) in the other 2 patients. One case of recurrence was reported 14 months after achieving CR. This patient was treated again with combined oral MPA/LNG-IUS and achieved CR by 6 months. The average follow-up period was 44.4 ± 26.2 months (range, 12–71 months). There were no cases of progressive disease. No treatment-related complications arose.ConclusionsCombined oral MPA/LNG-IUS treatment is considered to be a reasonably effective fertility-sparing treatment of grade 2 stage IA endometrial cancer. Although our results are encouraging, it is preliminary and should be considered with experienced oncologists in well-defined protocol and with close follow-up.

Hysteroscopic Resection in Fertility-Sparing Surgery for Atypical Hyperplasia and Endometrial Cancer: Safety and Efficacy

2015 ◽  
Vol 22 (7) ◽  
pp. 1178-1182 ◽  
Author(s):  
Patrizia De Marzi ◽  
Alice Bergamini ◽  
Stefania Luchini ◽  
Micaela Petrone ◽  
Gian Luca Taccagni ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Atypical Hyperplasia ◽  
Safety And Efficacy ◽  
Fertility Sparing Surgery ◽  
Fertility Sparing ◽  
Hysteroscopic Resection

scholarly journals Fertility-Sparing Methods in Adolescents Affected by Endometrial Cancer: A Comprehensive Review

2021 ◽  
Vol 10 (5) ◽  
pp. 1020
Author(s):  
Krzysztof Gałczyński ◽  
Piotr Olcha ◽  
Katarzyna Romanek-Piva ◽  
Maciej Jóźwik ◽  
Andrzej Semczuk
Keyword(s):  
Endometrial Cancer ◽  
World Literature ◽  
Young Patients ◽  
Developed Countries ◽  
Type I ◽  
Genetic Syndromes ◽  
Patient Death ◽  
Future Fertility ◽  
Fertility Sparing

Although in developed countries endometrial cancer (EC) is the most common gynecological malignancy, its occurrence in adolescents is exceedingly rare. The increasing rate of obesity in children and adolescents is held responsible for the increasing prevalence of EC in younger cohorts of patients. The diagnosis of this malignancy can have devastating consequences for future fertility because standard treatment protocols for EC include hysterectomy. Here, we present the first detailed review of the world literature on EC in subjects aged 21 years or younger (n = 19). The mean age at diagnosis was 16.7 ± 0.6 years. One patient (5.3%) had a Type II (high-risk) disease. No communication retrieved from the search reported on patient death; however, two (10.5%) patients were lost to follow-up. There was also a high proportion (five subjects, or 26.3%) of cases with genetic background (Cowden syndrome and Turner syndrome), therefore genetic screening or a direct genetic study should be considered in very young patients with EC. The current fertility-sparing options, limited to Type I (low-risk) disease, are presented and discussed. Such information, obtained from studies on older women, translates well to adolescent girls and very young women. Careful anatomopathological monitoring at follow-up is essential for the safety of a conservative approach. Improved survival in very young EC patients makes the preservation of fertility a central survivorship issue, therefore both patients and caregivers should undergo counseling regarding available options. Moreover, our study suggests that genetic syndromes other than Lynch syndrome may be associated with EC more frequently than previously thought.

scholarly journals Analysis of the Safety and Pregnant Outcomes of Fertility-Sparing Surgery in Ovarian Malignant Sex Cord-Stromal Tumors: A Multicenter Retrospective Study

2021 ◽  
Author(s):  
Junting Li ◽  
Ran Chu ◽  
Gang Chen ◽  
Yuanming Shen ◽  
Yanhui Lou ◽  
...  
Keyword(s):  
Risk Factors ◽  
Regression Analysis ◽  
High Risk ◽  
Stromal Tumors ◽  
High Risk Factors ◽  
Fertility Sparing Surgery ◽  
Fertility Sparing ◽  
Stage Ia ◽  
Staging Surgery ◽  
Sex Cord Stromal Tumors

Abstract Background: To assess the difference in survival between fertility-sparing surgery (FSS) and radical surgery (RS) and explore pregnant outcomes after FSS in stage I malignant sex cord-stromal tumors (MSCSTs).Methods: We performed a multicenter retrospective cohort study on patients who were diagnosed with stage IA or IC MSCSTs. Inverse Probability of Treatment Weighting was performed between the FSS and RS groups. The Chi-square test and Kaplan-Meier method were used to compare the categorical variables and disease-free survival (DFS). The binary logistic regression analysis and Cox proportional hazards regression analysis were used to identify high-risk factors related to DFS and pregnancy.Results: A total of 107 patients were included, of whom 54 (50.5%) women underwent FSS, and 53 (49.5%) women underwent RS. After IPTW, 208 patients were obtained, and all of the covariates were well balanced. After a median follow-up time of 50 months (range 7-156 months), there was no significant difference of DFS between the two groups in both unweighted cohort (P=0.969) or weighted cohort (P=0.792). In the weighted cohort, stage IC (P=0.014), tumor diameter >8 cm (P=0.003), incomplete staging surgery (P=0.003) and no adjuvant chemotherapy (P <0.001) were 4 high-risk factors associated with a shorter DFS. Among 14 patients who had pregnancy desire, 11 (78.6%) women conceived successfully, and the live birth rate was 76.9%. In univariate analysis, only adjuvant chemotherapy (P=0.009) was associated with infertility.Conclusions: On the premise of complete staging surgery, FSS is safe and feasible in stage IA and IC MSCSTs with satisfactory reproductive outcomes.

Sign in / Sign up

Export Citation Format

Share Document