J Gynecol Oncol.
2020 Sep;31(5):e74. 10.3802/jgo.2020.31.e74.
Fertility-sparing treatment for intramucous, moderately differentiated, endometrioid endometrial cancer: a Gynecologic Cancer Inter-Group (GCIG) study
- Falcone F
1 - Maggiore ULR2
- Donato VD3
- Perrone AM4
- Frigerio L5
- Bifulco G6
- Polterauer S7
- Casadio P8
- Cormio G9
- Masciullo V10
- Malzoni M11
- Greggi S1
- Affiliations
-
- 1Department of Gynecologic Oncology, Istituto Nazionale Tumori, IRCSS, “Fondazione G. Pascale”, Naples, Italy
- 2Gynecologic Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- 3Department of Maternal and Child Health and Urological Sciences, Umberto I, Sapienza University of Rome, Rome, Italy
- 4Gynecologic Oncology Unit, Sant'Orsola-Malpighi Hospital, and Centro di Studio e Ricerca delle Neoplasie Ginecologiche (CSR), University of Bologna, Bologna, Italy
- 5Obstetrics and Gynecology Department, ASST Papa Giovanni XXIII, Bergamo, Italy
- 6Department of Public Health, School of Medicine, University of Naples Federico II, Naples, Italy
- 7Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria
- 8Department of Obstetrics and Gynecology, DIMEC, Sant'Orsola Academic Hospital, University of Bologna, Italy
- 9Gynecologic Oncology Unit, IRCCS Istituto Tumori “Giovanni Paolo II”, Bari, Italy
- 10Gynecologic Oncology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Roma, Italy
- 11Endoscopica Malzoni, Center for Advanced Endoscopic Gynecologic Surgery, Avellino, Italy
- KMID: 2511984
- DOI: http://doi.org/10.3802/jgo.2020.31.e74
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.
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