Successful live birth after fertility-sparing
treatment in grade II endometrial cancer:
A case report

Relevance: The growing incidence of endometrial cancer among young women urges the use of fertility-sparing therapy. The purpose of this study was to demonstrate the results of using fertility-sparing therapy in a woman with endometrial cancer, FIGO stage IA GII. Results: After the combination hormone therapy with gonadotropin-releasing hormone (diphereline 3.75 mg every 28 days) using a hormone-releasing intrauterine device, the patient with endometrial cancer stage 1, GII demonstrated a complete response to treatment and delivered a live newborn. Conclusion: Surgery remains the primary treatment for the early stages of endometrial cancer. However, hormone therapy can preserve fertility in young women with highly differentiated early-stage endometrial cancer. The described schemes of hormone therapy can be used in young patients.

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Contemporary Fertility-Sparing Management Options of Early Stage Endometrioid Endometrial Cancer in Young Nulliparous Patients

Journal of Clinical Medicine ◽

10.3390/jcm11010196 ◽

2021 ◽

Vol 11 (1) ◽

pp. 196

Author(s):

Gulzhanat Aimagambetova ◽

Sanja Terzic ◽

Antonio Simone Laganà ◽

Gauri Bapayeva ◽

Philip la Fleur ◽

...

Keyword(s):

Endometrial Cancer ◽

Young Women ◽

Early Stage ◽

Young Patients ◽

Surgical Techniques ◽

Risk Groups ◽

Reproductive Age ◽

Management Options ◽

Minimally Invasive Surgical ◽

Fertility Sparing

Incidence of endometrial cancer (EC) has been increasing in recent years, especially in high-income countries. The disease commonly affects peri- and postmenopausal women; however, about 5% of women are diagnosed with EC in their reproductive age. Due to both the increasing incidence of EC among reproductive age women and trends to delayed childbearing, fertility-sparing treatment for young patients with EC has become extremely important for researchers and practitioners. Because the classic treatment with total hysterectomy and bilateral saplingo-oophorectomy is not an appropriate approach for young women demanding fertility preservation, several fertility-sparing options have been developed and summarized in this review. Utilization of different medications and their combination (progestagens, gonadotropin releasing hormones analogues, and metformin in different formulations) are tested and found as efficient for fertility-sparing treatment. New minimally invasive surgical techniques, combined with progestagens, are also confirmed as valuable. There are many novel conservative and surgical treatment approaches under investigation. Assuming that molecular biomarkers can be both diagnostic and prognostic to assist in prediction of response to a certain therapy, prognostic risk groups’ stratification along with specific biomarkers’ identification will ensure low recurrence and decrease mortality rates in young women with EC.

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Fertility-sparing management with progestin for young women with early-stage endometrial cancer and complex hyperplasia with atypia.

Journal of Clinical Oncology ◽

10.1200/jco.2010.28.15_suppl.5091 ◽

2010 ◽

Vol 28 (15_suppl) ◽

pp. 5091-5091

Author(s):

J. Park ◽

H. Roh ◽

W. Joo ◽

H. You ◽

D. Kim ◽

...

Keyword(s):

Endometrial Cancer ◽

Young Women ◽

Early Stage ◽

Fertility Sparing ◽

Early Stage Endometrial Cancer

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1 - FERTILITY SPARING TREATMENT WITH LEVONORGESTREL INTRAUTERINE DEVICE AFTER COMPLETE MACROSCOPIC HYSTEROSCOPIC RESECTION FOR WELL DIFFERENTIATED EARLY STAGE ENDOMETRIOD ADENOCARCINOMA IN YOUNG WOMEN

10.26226/morressier.5d2ee8e71e09a6f49485a926 ◽

2019 ◽

Author(s):

Kaabia Ons ◽

rym zgaya

Keyword(s):

Young Women ◽

Early Stage ◽

Intrauterine Device ◽

Fertility Sparing ◽

Well Differentiated ◽

Hysteroscopic Resection

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Predictability of later developed relapse in endometrial carcinoma in young women with functional imaging parameters of fes/FDG SUV ratio after fertility-sparing hormone treatment.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.e16502 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. e16502-e16502

Author(s):

Yoshio Yoshida ◽

Hidehiko Okazawa ◽

Akiko Shinagawa ◽

Yasushi Kiyono ◽

Tetsuya Mori ◽

...

Keyword(s):

Endometrial Carcinoma ◽

Young Women ◽

Young Patients ◽

Complete Response ◽

Hormone Treatment ◽

Tracer Uptake ◽

High Dose ◽

Standardized Uptake Values ◽

Fertility Sparing ◽

Significant Difference

e16502 Background: Even in responders of fertility-sparing hormone treatment for uterine endometrial carcinoma (EC) and atypical endometrial hyperplasia (AH) in young women, there have been high potential risks of later developed relapse. The aim of this study was whether changes in FDG and fluoroestradiol (FES) PET parameters following hormone treatment have the prognostic factor in prediction of later developed relapse. Methods: Eight young patients with EC and AH were treated by fertility-sparing treatment with a high-dose of medroxyprogesterone acetate (MPA) for 26 weeks. All patients underwent two FDG and FES-PET scans at baseline and 8 weeks after the beginning of MPA treatment, respectively. For each lesion, metabolic indices were calculated by standardized uptake values (SUV). All patients were followed up for 2 years. Values of FDG-SUV, FES-SUV and FES/FDG SUV ratio of tumors were retrospectively reviewed. The correlation between these parameters and clinical outcome of EC and AH for 2 years was evaluated. Results: An initial complete response was achieved in all patients. Two of 5 responders (40%) with AH and one of three (33%) responders with EC later developed (72-88weeks) relapse. One of those three patients underwent hysterectomy due to no response for additional MPA therapy. The tracer uptake of FDG and FES was decrease in all eight patients after 8 weeks. The FES/FDG ratio was increased in all three patients with later developed relapse, but the FES/FDG ratio was decrease in all patients without recurrence for 8 weeks. There was a significant difference of the change in FES/FDG ratio between later developed relapse patients and no relapse patients (0.113 vs -0.392; p = 0.044). Conclusions: This study suggests that an increase in the FES/FDG ratio after 8 weeks fertility-sparing hormone treatment with a high-dose of MPA may be a useful biomarker for predicting later developed relapse in EC and AH in young women.

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Prolonged Conservative Treatment of Endometrial Cancer Patients: More Than 1 Pregnancy Can Be Achieved

International Journal of Gynecological Cancer ◽

10.1097/igc.0b013e31820003de ◽

2011 ◽

Vol 21 (1) ◽

pp. 72-78 ◽

Cited By ~ 33

Author(s):

Tamar Perri ◽

Jacob Korach ◽

Walter H. Gotlieb ◽

Mario Beiner ◽

Dror Meirow ◽

...

Keyword(s):

Endometrial Cancer ◽

Conservative Treatment ◽

Early Stage ◽

Intrauterine Device ◽

Endometrial Adenocarcinoma ◽

Tertiary Care ◽

Young Patients ◽

High Recurrence Rate ◽

High Dose ◽

Endometrioid Adenocarcinoma

Background:Preserving reproductive function in young patients with early endometrial cancer is an accepted concept today. The safety and feasibility of long-term conservative treatment, allowing more than 1 pregnancy, remain to be ascertained.Methods:This study was a retrospective chart review of a 27 women with endometrioid adenocarcinoma of the endometrium, who were treated conservatively at 2 tertiary-care institutions. Treatment comprised oral high-dose progestins with or without a levonorgestrel-releasing intrauterine device. Endometrial biopsy was repeated every 2 to 3 months.Results:Over 7.8 to 412 months (median, 57.4 months), tumors regressed completely in 24 (89%) of 27 patients and partially in 2 patients, with 79% responding within 1 to 17 months. Of the complete responders, 15 (62%) of 24 had a recurrence; 4 underwent hysterectomy, and 11 underwent subsequent progestational treatment. All 11 responded, and 3 subsequently conceived. After 2 to 4 years, 5 patients again had a recurrence, of whom 3 underwent hysterectomy. Overall, 2 patients developed ovarian adenocarcinoma. All patients are currently disease-free. Conception occurred in 14 (51.8%) of 27 patients, in 5 more than once. There were 17 live births, and 2 patients are pregnant.Conclusions:According to our data, prolonged progestational therapy for early-stage endometrial adenocarcinoma, allowing women to conceive, is feasible and apparently does not alter clinical outcome. Patients should be advised of the high recurrence rate and possible concomitant ovarian malignancy.

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