J Gynecol Oncol.  2017 Jan;28(1):e2. 10.3802/jgo.2017.28.e2.

Fertility preserving treatment with hysteroscopic resection followed by progestin therapy in young women with early endometrial cancer

• Falcone F
• Laurelli G
• Losito S
• Di Napoli
• Granata V
• Greggi S

• KMID: 2413849
• DOI: http://doi.org/10.3802/jgo.2017.28.e2

Abstract

OBJECTIVE
To report our 15-year institutional experience of fertility-sparing treatment in young patients with early endometrial cancer (EC) treated by combined hysteroscopic resection and progestin therapy.
METHODS
Twenty-eight patients (stage IA, G1 and 2 endometrioid EC) wishing to preserve their fertility were enrolled into this prospective study. Hysteroscopic resection was used to resect the tumor, endometrium adjacent to the tumor and myometrium underlying the tumor. Adjuvant hormonal therapy consisted of oral megestrol acetate or levonorgestrel intrauterine device for 6 months or more.
RESULTS
After 3 months from the progestin start date, 25 patients (89.3%) showed a complete regression (median time to complete regression, 3 months [range, 3-9 months]), two (7.1%) showed persistent disease, while one patient (3.6%) presented with progressive disease and underwent definitive surgery (stage IA, G3 endometrioid). At 6 months, one of the two patients with persistent disease underwent definitive surgery (stage IA, G1 endometrioid), while the other one was successfully re-treated. Two recurrences were observed (7.7%) both involving the endometrium and synchronous ovarian cancer. The median duration of complete response was 94.5 months (range, 8-175 months). More than half of the responders (57.7%) attempted to conceive with 93.3% and 86.6% pregnancy and live birth rates, respectively.
CONCLUSION
The addition of a standardized three-step resectoscopy to progestin would seem to improve the efficacy of progestin alone. High pregnancy and live birth rates were observed in women attempting to conceive.

Keyword

Endometrial Neoplasms; Fertility Preservation; Hormonal Therapy; Hysteroscopy

MeSH Terms

Adult
Antineoplastic Agents, Hormonal/*administration & dosage
Chemotherapy, Adjuvant
Combined Modality Therapy
Endometrial Neoplasms/pathology/*therapy
Female
Fertility Preservation/*methods
Humans
*Hysteroscopy
Intrauterine Devices
Levonorgestrel/administration & dosage
Megestrol Acetate/*administration & dosage
Pregnancy
Progestins/*therapeutic use
Prospective Studies
Young Adult
Antineoplastic Agents, Hormonal
Progestins
Levonorgestrel
Megestrol Acetate