Oncological outcomes in fertility-sparing treatment in stage IA-G2 endometrial cancer

Carlo Ronsini; Lavinia Mosca; Irene Iavarone; Roberta Nicoletti; Davide Vinci; Raffaela Maria Carotenuto; Francesca Pasanisi; Maria Cristina Solazzo; Pasquale De Franciscis; Marco Torella; Marco La Verde; Nicola Colacurci; Luigi Cobellis; Giuseppe Vizzielli; Stefano Restaino

doi:10.3389/fonc.2022.965029

Oncological outcomes in fertility-sparing treatment in stage IA-G2 endometrial cancer

Front Oncol. 2022 Sep 16:12:965029. doi: 10.3389/fonc.2022.965029. eCollection 2022.

Authors

Carlo Ronsini¹, Lavinia Mosca¹, Irene Iavarone¹, Roberta Nicoletti¹, Davide Vinci¹, Raffaela Maria Carotenuto¹, Francesca Pasanisi¹, Maria Cristina Solazzo¹, Pasquale De Franciscis¹, Marco Torella¹, Marco La Verde¹, Nicola Colacurci¹, Luigi Cobellis¹, Giuseppe Vizzielli^{2

3}, Stefano Restaino^{2

3}

Affiliations

¹ Department of Woman, Child and General and Specialized Surgery, Obstetrics and Gynecology Unit, University of Campania "Luigi Vanvitelli", Naples, Italy.
² Department of Obstetrics, Gynecology, and Pediatrics, Obstetrics and Gynecology Unit, Udine University Hospital, Udine, Italy.
³ Dipartimento di Area Medica (DAME), Udine University Hospital, Udine, Italy.

Abstract

Background: The gold standard treatment for early-stage endometrial cancer (EC) is hysterectomy with bilateral salpingo-oophorectomy (BSO) with lymphadenectomy. In selected patients desiring pregnancy, fertility-sparing treatment (FST) can be adopted. Our review aims to collect the most incisive studies about the possibility of conservative management for patients with grade 2, stage IA EC. Different approaches can be considered beyond demolition surgery, such as local treatment with levonorgestrel-releasing intra-uterine device (LNG-IUD) plus systemic therapy with progestins.

Study design: Our systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. PubMed, EMBASE, and Scopus databases were consulted, and five studies were chosen based on the following criteria: patients with a histological diagnosis of EC stage IA G2 in reproductive age desiring pregnancy and at least one oncological outcome evaluated. Search imputes were "endometrial cancer" AND "fertility sparing" AND "oncologic outcomes" AND "G2 or stage IA".

Results: A total of 103 patients were included and treated with a combination of LNG-IUD plus megestrol acetate (MA) or medroxyprogesterone acetate (MPA), gonadotrophin-releasing hormone (GnRH) plus MPA/MA, hysteroscopic resectoscope (HR), and dilation and curettage (D&C). There is evidence of 70% to 85% complete response after second-round therapy prolongation to 12 months.

Conclusions: Conservative measures must be considered temporary to allow pregnancy and subsequently perform specific counseling to adopt surgery. Fertility-sparing management is not the current standard of care for young women with EC. It can be employed for patients with early-stage diseases motivated to maintain reproductive function. Indeed, the results are encouraging, but the sample size must be increased.

Keywords: endometrial cancer; fertility; levonorgestrel intrauterine device (IUD); medroxyprogesterone acetate; pregnancy outcomes.

Publication types

Systematic Review