EP515 Fertility-sparing hysteroscopic resection of the endometrium for patients with stage IA endometroid endometrial cancer: farghaly´s technique

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.

Download Full-text

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

Journal of Minimally Invasive Gynecology ◽

10.1016/j.jmig.2015.06.004 ◽

2015 ◽

Vol 22 (7) ◽

pp. 1178-1182 ◽

Cited By ~ 23

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

Download Full-text

Conservative Surgery in Endometrial Cancer

Journal of Clinical Medicine ◽

10.3390/jcm11010183 ◽

2021 ◽

Vol 11 (1) ◽

pp. 183

Author(s):

Alessandra Gallo ◽

Ursula Catena ◽

Gabriele Saccone ◽

Attilio Di Spiezio Sardo

Keyword(s):

Endometrial Cancer ◽

Standard Of Care ◽

Complete Response ◽

Conservative Surgery ◽

Primary Treatment ◽

Nccn Guidelines ◽

Fertility Sparing ◽

Age Of Diagnosis ◽

Cancer Network ◽

Hysteroscopic Resection

Endometrial cancer (EC) is the sixth most common female cancer worldwide. The median age of diagnosis is 65 years. However, 4% of women diagnosed with EC are younger than 40 years old, and 70% of these women are nulliparous. These data highlight the importance of preserving fertility in these patients, at a time when the average age of the first pregnancy is significantly delayed and is now firmly established at over 30 years of age. National Comprehensive Cancer Network (NCCN guidelines state that the primary treatment of endometrial endometrioid carcinoma, limited to the uterus, is a total hysterectomy, bilateral salpingo-oophorectomy and surgical staging. Fertility-sparing treatment is not the standard of care, and patients eligible for this treatment always have to undergo strict counselling. Nowadays, a combined approach consisting of hysteroscopic resection, followed by oral or intrauterine-released progestins, has been reported to be an effective fertility-sparing option. Hysteroscopic resection followed by progestins achieved a complete response rate of 95.3% with a recurrence rate of 14.1%. The pregnancy rate in women undergoing fertility-sparing treatment is 47.8%, but rises to 93.3% when only considering women who tried to conceive during the study period. The aim of the present review is to provide a literature overview reflecting the current state of fertility-sparing options for the management of EC, specific criteria for considering such options, their limits, the implications for reproductive outcomes and the latest research trends in this direction.

Download Full-text

Reply to “Hysteroscopic Resection in Fertility-Sparing Surgery for Atypical Hyperplasia and Endometrial Cancer: How Important Are Intrauterine Adhesions?”

Journal of Minimally Invasive Gynecology ◽

10.1016/j.jmig.2015.12.007 ◽

2016 ◽

Vol 23 (3) ◽

pp. 454-455 ◽

Cited By ~ 1

Author(s):

Patrizia De Marzi ◽

Alice Bergamini ◽

Stefania Luchini ◽

Micaela Petrone ◽

Gianluca Taccagni ◽

...

Keyword(s):

Endometrial Cancer ◽

Atypical Hyperplasia ◽

Intrauterine Adhesions ◽

Fertility Sparing Surgery ◽

Fertility Sparing ◽

Hysteroscopic Resection

Download Full-text

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

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2018-000036 ◽

2019 ◽

Vol 29 (1) ◽

pp. 77-85 ◽

Cited By ~ 9

Author(s):

Su Hyun Chae ◽

Seung-Hyuk Shim ◽

Sun Joo Lee ◽

Ji Young Lee ◽

Soo-Nyung Kim ◽

...

Keyword(s):

Endometrial Cancer ◽

Early Stage ◽

Disease Free Survival ◽

Oncologic Outcomes ◽

Survival Duration ◽

Rank Test ◽

Lower Grade ◽

Fertility Sparing ◽

Stage Ia ◽

Endometrioid Endometrial Cancer

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.

Download Full-text