Conservative treatment of early disease: A literature review

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Abstract

Approximately one fourth of women with endometrial cancer are diagnosed in fertile age. Nevertheless, the current standard of surgical approach is preclusive of fertility. Primary progestin therapy, sometimes combined with local surgical excision, has been used as conservative treatment in early well differentiated tumors. The worldwide experience and data, however, are still limited due to the small number of cases, potential methodological bias, and the use of different therapeutic regimes. In our experience, we have tested the feasibility and efficacy of combined operative hysteroscopy and hormone therapy as fertility-preserving treatment in a cohort of selected young women with FIGO stage IA (intramucous) well differentiated endometrial cancer (n=14). Treatment consisted of hysteroscopic ablation of the lesion and the myometrial tissue below, followed by oral megestrol acetate for 6 months or levonorgestrel-medicated intrauterine device for 12 months. With a median follow-up of 46 months, one patient recurred after 5 months from operative hysteroscopy and underwent definitive surgery, one patient showed an endometrial hyperplasia without atypia at the 3 and 6 month hysteroscopy control, with negative controls thereafter; three patients have attempted to conceive and one of them conceived and term delivered a healthy baby. A systematic review of the literature data published in the last twenty years on patients with endometrial cancer conservatively treated with fertility-sparing aims is reported. Twenty-eight papers on clinical series (n=347) and 7 unfavorable case reports are shown. By means of different strategies (hormonal therapy ± hysteroscopic resection) and using different drugs, a mean of 72% complete response was obtained, with a 23% relapse rate (only 4 disease-related deaths due to recurrence in the abdomen or distance site). So far, combined approach of operative hysteroscopy and hormonal therapy has been used only in very limited group of patients: of 20 cases treated, only one has relapsed (5%), compared to a mean of 24% following exclusive medical treatment reported in our review; although limited by a comparison not methodologically correct, it may be argued that operative hysteroscopy is of benefit in terms of cure. Twenty-eight percent of complete responders subsequently conceived with or without assisted reproduction technology, while the pregnancy rates ranging from 32% to 100% in patients attempting to conceive.

Original languageEnglish
Title of host publicationEndometrial Cancer: Prevention, Diagnosis and Treatment
PublisherNova Science Publishers, Inc.
Pages145-160
Number of pages16
ISBN (Print)9781622577408
Publication statusPublished - Feb 2013

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

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