Fertility-Sparing Treatment in Endometrial Cancer
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Published:
Jul 10, 2019
Keywords:
Endometrial cancer Fertility-sparing treatment Progestin
Main Article Content
Abstract
Endometrial cancer is one of the most common gynecologic cancers in Thailand. Approximately 15-25% of women are diagnosed during their premenopausal period. Standard treatment of endometrial cancer includes total abdominal hysterectomy and bilateral salpingo-oophorectomy with staging procedures. However, conservative management with progestin therapy may be considered in selected patients for fertility preservation. Candidates for fertility-sparing treatment are women with early stage, well differentiated endometrioid adenocarcinoma without myometrial invasion. Oncologic and fertility outcomes of patients treated with conservative management are limited. Therefore, close surveillance is needed during conservative management. Definitive treatment should be performed after completion of childbearing.
Article Details
How to Cite
(1)
Poomtavorn, Y. Fertility-Sparing Treatment in Endometrial Cancer. Thai J Obstet Gynaecol 2019, 27, 118-121.
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Special Article
References
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8. Navarria I, Usel M, Rapiti E, Neyroud-Caspar I, Pelte MF, Bouchardy C, et al. Young patients with endometrial cancer: how many could be eligible for fertility-sparing treatment? Gynecol Oncol 2009;114:448-51.
9. Lee NK, Cheung MK, Shin JY, Husain A, Teng NN, Berek JS, et al. Prognostic factors for uterine cancer in reproductive-aged women. Obstet Gynecol 2007;109: 655-62.
10. Koh WJ, Abu-Rustum NR, Bean S, Bradley K, Campos SM, Cho KR, et al. Uterine Neoplasms, Version 1. 2018, NCCN Clinical Practical Guidelines in Oncology. J Natl Compr Canc Netw 2018;16:170-99.
11. Larson DM, Johnson KK, Broste SK, Krawisz BR, Kresl JJ. Comparison of D&C and office endometrial biopsy in predicting final histopathologic grade in endometrial cancer. Obstet Gynecol 1995;86:38-42.
12. Biewenga P, de Blok S, Birnie E. Does diagnostic hysteroscopy in patients with stage I endometrial carcinoma cause positive peritoneal washing? Gynecol Oncol 2004;93:194-8.
13. Selvaggi L, Cormio G, Ceci O, Loverro G, Cazzolla A, Bettocchi S. Hysteroscopy does not increase the risk of microscopic extrauterine spread in endometrial carcinoma. Int J Gynecol Cancer 2003;13:223-7.
14. Barwick TD, Rockall AG, Barton DP, Sohaib SA. Imaging of endometrial adenocarcinoma. Clin Radiol 2006;61: 545-55.
15. Eriksson LS, Lindqvist PG, Floter Radestad A, Dueholm M, Fischerova D, Franchi D, et al. Transvaginal ultrasound assessment of myometrial and cervical stromal invasion in women with endometrial cancer: interobserver reproducibility among ultrasound experts and gynecologists. Ultrasound Obstet Gynecol 2015; 45:476-82.
16. Andreano A, Rechichi G, Rebora P, Sironi S, Valsecchi MG, Galimberti S. MR diffusion imaging for preoperative staging of myometrial invasion in patients with endometrial cancer: a systematic review and meta-analysis. Eur Radiol 2014;24:1327-38.
17. Ramirez PT, Frumovitz M, Bodurka DC, Sun CC, Levenback C. Hormonal therapy for the management of grade 1 endometrial adenocarcinoma: A literature review. Gynecol Oncol 2004;95:133-8.
18. Tangjitgamol S, Manusirivithaya S, Hanprasertpong J. Fertility-sparing in endometrial cancer. Gynecol Obstet Invest 2009;67:250-68.
19. Erkanli S, Ayhan A. Fertility-sparing therapy in young women with endometrial cancer: 2010 update. Int J Gynecol Cancer 2010;20:1170-87.
20. Park JY, Kin DY, Kim JH, Kim YM, Kim KR, Kim YT, et al. Long-term oncologic outcomes after fertility-sparing management using oral progestin for young women with endometrial cancer (KGOG 2002) Eur J cancer 2013;49:868-74.
21. Gunderson CC, Fader AN, Carson KA, Bristow RE. Oncologic and reproductive outcomes with progestin therapy in women with endometrial hyperplasia and grade I adenocarcinoma: a systematic review. Gynecol Oncol 2012;125:477-82.
22. Galls ID, Shehmar M, Thangaratinam S, Papapostolou TK, Coomarasamy A, Gupta JK. Oral progestogens vs levonorgestrel-releasing intrauterine system for endometrial hyperplasia: a systematic review and mataanalysis. Am J Obstet Gynecol 2010;203:547.e1-10.
23. Abu Hashim H, Ghayaty E, El Rakhawy M. Levonorgestrel-releasing intrauterine system vs oral progestins for non-atypical endometrial hyperplasia: a systematic review and metaanalysis of randomized trials. Am J Obstet Gynecol 2015;213:469-78.
24. Kaku T, Yoshikawa H, Tsuda H, Sakamoto A, Fukunaga M, Kuwabara Y, et al. Conservative therapy for adenocarcinoma and atypical endometrial hyperplasia of the endometrium in young women: central pathologic review and treatment outcome. Cancer Lett 2001;167: 39-48.
25. Hahn HS, Yoon SG, Hong JS, Hong SR, Park SJ, Lim JY, et al. Conservative treatment with progestin and pregnancy outcomes in endometrial cancer. Int J Gynecol Cancer 2009;19:1068-73.
26. Chiva L, Lapuente F, Gonzalez-Cortijo L, Carballo N, Garcia JF, Rojo A, et al. Sparing fertility in young patients with endometrial cancer. Gynecol Oncol 2008;111:S101-4.
27. Yahata T, Fujita K, Aoki Y, Tanaka K. Long-term conservative therapy for endometrial adenocarcinoma in young women. Hum Reprod 2006;21:1070-5.
28. Bakkum-Gamez J, Kalogera E, Keeney G, Mariani A, Podratz K, Dowdy S. Conservative management of atypical hyperplasia and grade I endometrial carcinoma: Review of the literature and presentation of a series. J Gynecol Surg 2012;28:262-9.
29. Baker J, Obermair A, Gebski V, Janda M. Efficacy of oral or intrauterine device-delivered progestin in patients with complex endometrial hyperplasia with atypia or early endometrial adenocarcinoma: A meta-analysis and systematic review of the literature. Gynecol Oncol 2012;125:263-70.
30. Wei J, Zhang W, Feng L, Gao W. Comparison of fertility-sparing treatments in patients with early endometrial cancer and atypical complex hyperplasia: a meta-analysis and systematic review. Medicine (Baltimore) 2017;96:e8034.
2. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics, CA Cancer J Clin 2011;61: 69-90.
3. Siegel R, Ma J, Zou Z, Jemal A. Cancer statistics, 2014. CA Can J Clin 2014;64:9-29.
4. Duska LR, Garrett A, Rueda BR, Hass J, Chang Y, Fuller AF. Endometrial cancer in women 40 years old or younger. Gynecol Oncol 2001;83:388-93.
5. Crissman JD, Azoury RS, Barnes AE, Scgellhas HF. Endometrial carcinoma in women 40 years of age or younger. Obstet Gynecol 1981;57:699-704.
6. Barry JA, Azizia MM, Hardiman PJ. Risk of endometrial, ovarian and breast cancer in women with polycystic ovary syndrome: a systematic review and meta-analysis. Hum Reprod Update 2014;20:748-58.
7. Zivanovic O, Carter J, Kauff ND, Barakat RR. A review of the challenges faced in the conservative treatment of young women with endometrial carcinoma and risk of ovarian cancer. Gynecol Oncol 2009;115:504-9.
8. Navarria I, Usel M, Rapiti E, Neyroud-Caspar I, Pelte MF, Bouchardy C, et al. Young patients with endometrial cancer: how many could be eligible for fertility-sparing treatment? Gynecol Oncol 2009;114:448-51.
9. Lee NK, Cheung MK, Shin JY, Husain A, Teng NN, Berek JS, et al. Prognostic factors for uterine cancer in reproductive-aged women. Obstet Gynecol 2007;109: 655-62.
10. Koh WJ, Abu-Rustum NR, Bean S, Bradley K, Campos SM, Cho KR, et al. Uterine Neoplasms, Version 1. 2018, NCCN Clinical Practical Guidelines in Oncology. J Natl Compr Canc Netw 2018;16:170-99.
11. Larson DM, Johnson KK, Broste SK, Krawisz BR, Kresl JJ. Comparison of D&C and office endometrial biopsy in predicting final histopathologic grade in endometrial cancer. Obstet Gynecol 1995;86:38-42.
12. Biewenga P, de Blok S, Birnie E. Does diagnostic hysteroscopy in patients with stage I endometrial carcinoma cause positive peritoneal washing? Gynecol Oncol 2004;93:194-8.
13. Selvaggi L, Cormio G, Ceci O, Loverro G, Cazzolla A, Bettocchi S. Hysteroscopy does not increase the risk of microscopic extrauterine spread in endometrial carcinoma. Int J Gynecol Cancer 2003;13:223-7.
14. Barwick TD, Rockall AG, Barton DP, Sohaib SA. Imaging of endometrial adenocarcinoma. Clin Radiol 2006;61: 545-55.
15. Eriksson LS, Lindqvist PG, Floter Radestad A, Dueholm M, Fischerova D, Franchi D, et al. Transvaginal ultrasound assessment of myometrial and cervical stromal invasion in women with endometrial cancer: interobserver reproducibility among ultrasound experts and gynecologists. Ultrasound Obstet Gynecol 2015; 45:476-82.
16. Andreano A, Rechichi G, Rebora P, Sironi S, Valsecchi MG, Galimberti S. MR diffusion imaging for preoperative staging of myometrial invasion in patients with endometrial cancer: a systematic review and meta-analysis. Eur Radiol 2014;24:1327-38.
17. Ramirez PT, Frumovitz M, Bodurka DC, Sun CC, Levenback C. Hormonal therapy for the management of grade 1 endometrial adenocarcinoma: A literature review. Gynecol Oncol 2004;95:133-8.
18. Tangjitgamol S, Manusirivithaya S, Hanprasertpong J. Fertility-sparing in endometrial cancer. Gynecol Obstet Invest 2009;67:250-68.
19. Erkanli S, Ayhan A. Fertility-sparing therapy in young women with endometrial cancer: 2010 update. Int J Gynecol Cancer 2010;20:1170-87.
20. Park JY, Kin DY, Kim JH, Kim YM, Kim KR, Kim YT, et al. Long-term oncologic outcomes after fertility-sparing management using oral progestin for young women with endometrial cancer (KGOG 2002) Eur J cancer 2013;49:868-74.
21. Gunderson CC, Fader AN, Carson KA, Bristow RE. Oncologic and reproductive outcomes with progestin therapy in women with endometrial hyperplasia and grade I adenocarcinoma: a systematic review. Gynecol Oncol 2012;125:477-82.
22. Galls ID, Shehmar M, Thangaratinam S, Papapostolou TK, Coomarasamy A, Gupta JK. Oral progestogens vs levonorgestrel-releasing intrauterine system for endometrial hyperplasia: a systematic review and mataanalysis. Am J Obstet Gynecol 2010;203:547.e1-10.
23. Abu Hashim H, Ghayaty E, El Rakhawy M. Levonorgestrel-releasing intrauterine system vs oral progestins for non-atypical endometrial hyperplasia: a systematic review and metaanalysis of randomized trials. Am J Obstet Gynecol 2015;213:469-78.
24. Kaku T, Yoshikawa H, Tsuda H, Sakamoto A, Fukunaga M, Kuwabara Y, et al. Conservative therapy for adenocarcinoma and atypical endometrial hyperplasia of the endometrium in young women: central pathologic review and treatment outcome. Cancer Lett 2001;167: 39-48.
25. Hahn HS, Yoon SG, Hong JS, Hong SR, Park SJ, Lim JY, et al. Conservative treatment with progestin and pregnancy outcomes in endometrial cancer. Int J Gynecol Cancer 2009;19:1068-73.
26. Chiva L, Lapuente F, Gonzalez-Cortijo L, Carballo N, Garcia JF, Rojo A, et al. Sparing fertility in young patients with endometrial cancer. Gynecol Oncol 2008;111:S101-4.
27. Yahata T, Fujita K, Aoki Y, Tanaka K. Long-term conservative therapy for endometrial adenocarcinoma in young women. Hum Reprod 2006;21:1070-5.
28. Bakkum-Gamez J, Kalogera E, Keeney G, Mariani A, Podratz K, Dowdy S. Conservative management of atypical hyperplasia and grade I endometrial carcinoma: Review of the literature and presentation of a series. J Gynecol Surg 2012;28:262-9.
29. Baker J, Obermair A, Gebski V, Janda M. Efficacy of oral or intrauterine device-delivered progestin in patients with complex endometrial hyperplasia with atypia or early endometrial adenocarcinoma: A meta-analysis and systematic review of the literature. Gynecol Oncol 2012;125:263-70.
30. Wei J, Zhang W, Feng L, Gao W. Comparison of fertility-sparing treatments in patients with early endometrial cancer and atypical complex hyperplasia: a meta-analysis and systematic review. Medicine (Baltimore) 2017;96:e8034.