Fertility-sparing treatment for intramucous, moderately differentiated, endometrioid endometrial cancer: a Gynecologic Cancer Inter-Group (GCIG) study

Francesca Falcone, Umberto Leone Roberti Maggiore, Violante Di Donato, Anna Myriam Perrone, Luigi Frigerio, Giuseppe Bifulco, Stephan Polterauer, Paolo Casadio, Gennaro Cormio, Valeria Masciullo, Mario Malzoni, Stefano Greggi

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: 'The Endometrial Cancer Conservative Treatment (E.C.Co.). A multicentre archive' is a worldwide project endorsed by the Gynecologic Cancer Inter-Group, aimed at registering conservatively treated endometrial cancer (EC) patients. This paper reports the oncological and reproductive outcomes of intramucous, G2, endometrioid EC patients from this archive. METHODS: Twenty-three patients (Stage IA, G2, endometrioid EC) were enrolled between January 2004 and March 2019. Primary and secondary endpoints were, respectively, complete regression (CR) and recurrence rates, and pregnancy and live birth rates. RESULTS: A median follow-up of 35 months (9-148) was achieved. Hysteroscopic resection (HR) plus progestin was adopted in 74% (17/23) of cases. Seventeen patients showed CR (median time to CR, 6 months; 3-13). Among the 6 non-responders, one showed persistence and 5 progressed, all submitted to definitive surgery, with an unfavorauble outcome in one. The recurrence rate was 41.1%. Ten (58.8%) complete responders attempted to conceive, of whom 3 achieved at least one pregnancy with a live-birth. Two out of the 11 candidate patients underwent definitive surgery, while the remaining 9 have so far refused. To date, 22 patients show no evidence of disease, and one is still alive with disease. CONCLUSIONS: Fertility-sparing treatment seems to be feasible even in G2 EC, although caution should be kept considering the potential pathological undergrading or non-endometrioid histology misdiagnosis. The low rate of attempt to conceive and of compliance to definitive surgery underline the need for a 'global' counselling extended to the follow-up period.

Original languageEnglish
Pages (from-to)e74
JournalJournal of Gynecologic Oncology
Volume31
Issue number5
DOIs
Publication statusPublished - Sep 1 2020

Keywords

  • Endometrial Neoplasm
  • Fertility Preservation
  • Hysteroscopy

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynaecology

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    Falcone, F., Leone Roberti Maggiore, U., Di Donato, V., Perrone, A. M., Frigerio, L., Bifulco, G., Polterauer, S., Casadio, P., Cormio, G., Masciullo, V., Malzoni, M., & Greggi, S. (2020). Fertility-sparing treatment for intramucous, moderately differentiated, endometrioid endometrial cancer: a Gynecologic Cancer Inter-Group (GCIG) study. Journal of Gynecologic Oncology, 31(5), e74. https://doi.org/10.3802/jgo.2020.31.e74