Víctor Lago1, Tiermes Marina2,3, María Laseca Modrego4, Blanca Gil-Ibañez5, José Ramón Rodriguez6, Javier Domingo7, Lucas Minig8, Pablo Padilla-Iserte2, Octavio Arencibia Sánchez4, Manuela Sala Ferichola9, Merixell Munmanny3, Belén Martín Salamanca10, Sara Iacoponi11, Silvia Cabrera12, Pluvio Coronado13, Jesús Utrilla-Layna14, Águeda Bataller15, Gabriel Fiol16, Shiana Corbalán17, Elena Espinosa18, Antonio Gil-Moreno12, Santiago Domingo2. 1. Gynecologic Oncology Department, University Hospital La Fe, Valencia, Spain. victor.lago.leal@hotmail.com. 2. Gynecologic Oncology Department, University Hospital La Fe, Valencia, Spain. 3. Obstetrics and Gynecology Department, Clinic University Hospital, Barcelona, Spain. 4. Gynecologic Oncology Department, Maternal and Child University Hospital of the Canarias, Canari Island, Spain. 5. Gynecologic Oncology Department, University Hospital, 12 de Octubre, Madrid, Spain. 6. Obstetrics and Gynecology Department, Clinic and University Hospital Virgen de la Arrixaca, Murcia, Spain. 7. IVI Las Palmas, Las Palmas de Gran Canaria, Spain. 8. Department of Gynecology, CEU Cardenal Herrera University, Valencia, Spain. 9. Obstetrics and Gynecology Department, General University Hospital of Alicante, Alicante, Spain. 10. Obstetrics and Gynecology Department, University Hospital Getafe, Madrid, Spain. 11. Gynecologic Oncology Department, Hospital Quironsalud Madrid, Madrid, Spain. 12. Gynecologic Oncology Department, University Hospital Vall d´Hebron, Barcelona, Spain. 13. Obstetrics and Gynecology Department, Clinic University Hospital San Carlos, Madrid, Spain. 14. University Hospital Fundación Jimenez Díaz, Madrid, Spain. 15. Obstetrics and Gynecology Department, University Hospital of La Rivera, Alzira, Spain. 16. Gynecologic Oncology Department, University Hospital Torrecárdenas, Almeria, Spain. 17. Obstetrics and Gynecology Department, University Hospital Los Arcos, Murcia, Spain. 18. Clínica Espinosa, Valencia, Spain.
Abstract
OBJECTIVE: The primary objective was to evaluate the response rate of conservative treatment for endometrial cancer, and the secondary objective was to assess oncological, fertility and obstetric outcomes in patients who underwent fertility preservation treatment. MATERIAL AND METHODS: This multicentre, observational, retrospective study evaluated endometrial cancer patients who underwent fertility-sparing treatment in Spanish centres between January 2010 and January 2020. Seventy-three patients with stage IA endometrioid adenocarcinoma of the uterus were included in the study. RESULTS: The levonorgestrel intrauterine device (LNG-IUD) was the most common fertility-sparing treatment (53.4%), followed by megestrol acetate (20.5%) and medroxyprogesterone acetate (16.4%). During the 24-month follow-up period, the rate of complete response to fertility-sparing management was 74% (n = 54), and 8.2% (n = 6) of patients presented a partial response. Additionally, 13 (17.8%) patients presented with persistent disease and six (8.2%) relapsed after response. The LNG-IUD was associated with a higher complete response rate than the other methods (87.2 vs. 58.8%; p = 0.01). Surgical treatment (at least hysterectomy) was performed in 44 (60.3%) patients as the end of fertility-sparing treatment. Four (5.5%) patients presented relapse after surgery, associated with final FIGO stage III (p = 0.036), myometrial invasion > 50% (p = 0.018) and final tumour grade 2-3 (p = 0.018). The mean follow-up period was 57.8 (range 6-159) months. The 5-year relapse-free survival and overall survival rates were 92.6% [95% CI (81.3, 97.2)] and 93.5% [95% CI (80.7, 97.9)], respectively. During follow-up, three patients (4.1%) died of the disease after completion of surgical treatment. Up to 50.7% of patients included in the study attempted to get pregnant. Of these, the rate of pregnancy was 81.1% (n = 30/37), and reproductive techniques were used for this purpose in 78.4% of cases. CONCLUSIONS: Fertility-sparing management presented a high response rate in patients with endometrial cancer. LNG-IUD was associated with a better response rate compared to the other treatment options. Moreover, in patients using this management method, pregnancy could be achieved using reproductive techniques.
OBJECTIVE: The primary objective was to evaluate the response rate of conservative treatment for endometrial cancer, and the secondary objective was to assess oncological, fertility and obstetric outcomes in patients who underwent fertility preservation treatment. MATERIAL AND METHODS: This multicentre, observational, retrospective study evaluated endometrial cancer patients who underwent fertility-sparing treatment in Spanish centres between January 2010 and January 2020. Seventy-three patients with stage IA endometrioid adenocarcinoma of the uterus were included in the study. RESULTS: The levonorgestrel intrauterine device (LNG-IUD) was the most common fertility-sparing treatment (53.4%), followed by megestrol acetate (20.5%) and medroxyprogesterone acetate (16.4%). During the 24-month follow-up period, the rate of complete response to fertility-sparing management was 74% (n = 54), and 8.2% (n = 6) of patients presented a partial response. Additionally, 13 (17.8%) patients presented with persistent disease and six (8.2%) relapsed after response. The LNG-IUD was associated with a higher complete response rate than the other methods (87.2 vs. 58.8%; p = 0.01). Surgical treatment (at least hysterectomy) was performed in 44 (60.3%) patients as the end of fertility-sparing treatment. Four (5.5%) patients presented relapse after surgery, associated with final FIGO stage III (p = 0.036), myometrial invasion > 50% (p = 0.018) and final tumour grade 2-3 (p = 0.018). The mean follow-up period was 57.8 (range 6-159) months. The 5-year relapse-free survival and overall survival rates were 92.6% [95% CI (81.3, 97.2)] and 93.5% [95% CI (80.7, 97.9)], respectively. During follow-up, three patients (4.1%) died of the disease after completion of surgical treatment. Up to 50.7% of patients included in the study attempted to get pregnant. Of these, the rate of pregnancy was 81.1% (n = 30/37), and reproductive techniques were used for this purpose in 78.4% of cases. CONCLUSIONS: Fertility-sparing management presented a high response rate in patients with endometrial cancer. LNG-IUD was associated with a better response rate compared to the other treatment options. Moreover, in patients using this management method, pregnancy could be achieved using reproductive techniques.
Authors: Halina M Zyczynski; Larry T Sirls; W Jerod Greer; David D Rahn; Elizabeth Casiano; Peggy Norton; Hae-Young Kim; Linda Brubaker Journal: Am J Obstet Gynecol Date: 2013-12-28 Impact factor: 8.661
Authors: M Cubo-Abert; B Díaz-Feijoo; M Bradbury; N-L Rodríguez-Mías; M Vera; S Pérez-Hoyos; J-J Gómez-Cabeza; A Gil-Moreno Journal: Ultrasound Obstet Gynecol Date: 2021-09 Impact factor: 7.299
Authors: Ida Pino; Anna Daniela Iacobone; Ailyn Mariela Vidal Urbinati; Maria Di Giminiani; Davide Radice; Maria Elena Guerrieri; Eleonora Petra Preti; Silvia Martella; Dorella Franchi Journal: Cancers (Basel) Date: 2022-04-26 Impact factor: 6.575