Fertility-Sparing Treatment of Patients with Endometrial Cancer: A Review of the Literature.

Umberto Leone Roberti Maggiore,Nicola Luigi Bragazzi,Giorgio Bogani,Francesco Raspagliesi,Salvatore Lopez,Mauro Signorelli,Antonino Ditto,Rola Khamisy-Farah,Valentina Chiappa,Fabio Martinelli

doi:10.3390/jcm10204784

Umberto Leone Roberti Maggiore, Nicola Luigi Bragazzi + Show 8 more

Open Access

https://doi.org/10.3390/jcm10204784

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Abstract

Endometrial cancer (EC) is currently the most common malignancy of the female genital tract in developed countries. Although it is more common in postmenopausal women, it may affect up to 25% in the premenopausal age and 3–5% under the age of 40 years. Furthermore, in the last decades a significant shift to pregnancy at older maternal ages, particularly in resource-rich countries, has been observed. Therefore, in this scenario fertility-sparing alternatives should be discussed with patients affected by EC. This study summarizes available literature on fertility-sparing management of patients affected by EC, focusing on the oncologic and reproductive outcomes. A systematic computerized search of the literature was performed in two electronic databases (PubMed and MEDLINE) in order to identify relevant articles to be included for the purpose of this systematic review. On the basis of available evidence, fertility-sparing alternatives are oral progestins alone or in combination with other drugs, levonorgestrel intrauterine system and hysteroscopic resection in association with progestin therapies. These strategies seem feasible and safe for young patients with G1 endometrioid EC limited to the endometrium. However, there is a lack of high-quality evidence on the efficacy and safety of fertility-sparing treatments and future well-designed studies are required.

Highlights

Endometrial cancer (EC) is currently the most common malignancy of the female genital tract in developed countries; in Europe, EC has shown a 5-year prevalence of 34.7% (445,805 cases) [1]
Several types of treatment have been described for the fertility-sparing management of EC; no consensus is established on which agent, dose, or duration of treatment is more efficacious
This study demonstrated that hysteroscopic resection followed by oral progestins versus oral progestins alone caused a higher pooled regression (98.1% vs. 77.2%) and live birth rate (52.6% vs. 33.4%) and a lower recurrence rate compared with (4.8% vs. 32.2%)

Summary

Introduction

Endometrial cancer (EC) is currently the most common malignancy of the female genital tract in developed countries; in Europe, EC has shown a 5-year prevalence of 34.7% (445,805 cases) [1]. In 2018, the estimated number of new EC cases in Europe was 121,578 with 29,638 deaths, with aging and increasing obesity among women representing the two principal risk factors [2]. EC is more common among patients of postmenopausal age, but about 25% women are premenopausal and 3–5% are younger than 40 years [3]. The standard surgical treatment may not be suitable for patients wishing to maintain their fertility. Fertility-sparing alternatives should be thoroughly explained to EC women, discussing the oncologic outcomes related to each approach. Different conservative modalities have been demonstrated safe and feasible such as oral/local progestin treatment +/− hysteroscopic resection of endometrial lesions [10]

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