Preserving fertility in young patients with endometrial cancer: Current perspective

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Endometrial cancer (EC) is the most common gynecologic malignancy in developed countries and affects predominantly postmenopausal women. It is estimated, however, that 15%-25% of women will be diagnosed before menopause. As more women choose to defer childbearing until later in life, the feasibility and safety of fertility-sparing EC management have been increasingly studied. Definitive treatment of total hysterectomy and bilateral salpingooophorectomy precludes future fertility and may thus be undesirable by women who wish to maintain their reproductive potential. However, the consideration of conservative management carries the oncologic risks of unstaged EC and the risk of missing a synchronous ovarian cancer. It is further complicated by the lack of consensus regarding the initial assessment, treatment, and surveillance. Conservative treatment with progestins has been shown to be a feasible and safe fertility-sparing approach for women with low grade, early stage EC with no myometrial invasion. The two most commonly adopted regimens are medroxyprogesterone acetate at 500-600 mg daily and megestrol acetate at 160 mg daily for a minimum of 6-9 months, with initial response rates commonly reported between 60% and 80% and recurrence rates between 25% and 40%. Photodynamic therapy and hysteroscopic EC excision have recently been reported as alternative approaches to progestin therapy alone. However, limited efficacy and safety data exist. Live birth rates after progestin therapy have typically been reported around 30%; however, when focusing only on those who do pursue fertility after successful treatment, the live birth rates were found to be higher than 60%. Assisted reproductive technology has been associated with a higher live birth rate compared with spontaneous conception, most likely reflecting the presence of infertility at baseline. Close follow-up is of paramount importance, and definitive treatment after completion of childbearing is advised.

Original languageEnglish (US)
Pages (from-to)691-701
Number of pages11
JournalInternational Journal of Women's Health
Volume6
Issue number1
DOIs
StatePublished - Jul 29 2014

Fingerprint

Endometrial Neoplasms
Fertility
Birth Rate
Live Birth
Progestins
Therapeutics
Megestrol Acetate
Safety
Assisted Reproductive Techniques
Medroxyprogesterone Acetate
Photochemotherapy
Menopause
Hysterectomy
Developed Countries
Ovarian Neoplasms
Infertility
Recurrence
Neoplasms

Keywords

  • Conservative
  • Early stage endometrial cancer
  • Fertility sparing
  • Levonorgestrel intrauterine device
  • Preserving fertility
  • Progestin
  • Treatment

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Oncology
  • Maternity and Midwifery

Cite this

Preserving fertility in young patients with endometrial cancer : Current perspective. / Kalogera, Eleftheria; Dowdy, Sean Christopher; Bakkum-Gamez, Jamie N.

In: International Journal of Women's Health, Vol. 6, No. 1, 29.07.2014, p. 691-701.

Research output: Contribution to journalArticle

@article{8246a410fa3e4b4e8940a63086d72174,
title = "Preserving fertility in young patients with endometrial cancer: Current perspective",
abstract = "Endometrial cancer (EC) is the most common gynecologic malignancy in developed countries and affects predominantly postmenopausal women. It is estimated, however, that 15{\%}-25{\%} of women will be diagnosed before menopause. As more women choose to defer childbearing until later in life, the feasibility and safety of fertility-sparing EC management have been increasingly studied. Definitive treatment of total hysterectomy and bilateral salpingooophorectomy precludes future fertility and may thus be undesirable by women who wish to maintain their reproductive potential. However, the consideration of conservative management carries the oncologic risks of unstaged EC and the risk of missing a synchronous ovarian cancer. It is further complicated by the lack of consensus regarding the initial assessment, treatment, and surveillance. Conservative treatment with progestins has been shown to be a feasible and safe fertility-sparing approach for women with low grade, early stage EC with no myometrial invasion. The two most commonly adopted regimens are medroxyprogesterone acetate at 500-600 mg daily and megestrol acetate at 160 mg daily for a minimum of 6-9 months, with initial response rates commonly reported between 60{\%} and 80{\%} and recurrence rates between 25{\%} and 40{\%}. Photodynamic therapy and hysteroscopic EC excision have recently been reported as alternative approaches to progestin therapy alone. However, limited efficacy and safety data exist. Live birth rates after progestin therapy have typically been reported around 30{\%}; however, when focusing only on those who do pursue fertility after successful treatment, the live birth rates were found to be higher than 60{\%}. Assisted reproductive technology has been associated with a higher live birth rate compared with spontaneous conception, most likely reflecting the presence of infertility at baseline. Close follow-up is of paramount importance, and definitive treatment after completion of childbearing is advised.",
keywords = "Conservative, Early stage endometrial cancer, Fertility sparing, Levonorgestrel intrauterine device, Preserving fertility, Progestin, Treatment",
author = "Eleftheria Kalogera and Dowdy, {Sean Christopher} and Bakkum-Gamez, {Jamie N}",
year = "2014",
month = "7",
day = "29",
doi = "10.2147/IJWH.S47232",
language = "English (US)",
volume = "6",
pages = "691--701",
journal = "International Journal of Women's Health",
issn = "1179-1411",
publisher = "Dove Medical Press Ltd.",
number = "1",

}

TY - JOUR

T1 - Preserving fertility in young patients with endometrial cancer

T2 - Current perspective

AU - Kalogera, Eleftheria

AU - Dowdy, Sean Christopher

AU - Bakkum-Gamez, Jamie N

PY - 2014/7/29

Y1 - 2014/7/29

N2 - Endometrial cancer (EC) is the most common gynecologic malignancy in developed countries and affects predominantly postmenopausal women. It is estimated, however, that 15%-25% of women will be diagnosed before menopause. As more women choose to defer childbearing until later in life, the feasibility and safety of fertility-sparing EC management have been increasingly studied. Definitive treatment of total hysterectomy and bilateral salpingooophorectomy precludes future fertility and may thus be undesirable by women who wish to maintain their reproductive potential. However, the consideration of conservative management carries the oncologic risks of unstaged EC and the risk of missing a synchronous ovarian cancer. It is further complicated by the lack of consensus regarding the initial assessment, treatment, and surveillance. Conservative treatment with progestins has been shown to be a feasible and safe fertility-sparing approach for women with low grade, early stage EC with no myometrial invasion. The two most commonly adopted regimens are medroxyprogesterone acetate at 500-600 mg daily and megestrol acetate at 160 mg daily for a minimum of 6-9 months, with initial response rates commonly reported between 60% and 80% and recurrence rates between 25% and 40%. Photodynamic therapy and hysteroscopic EC excision have recently been reported as alternative approaches to progestin therapy alone. However, limited efficacy and safety data exist. Live birth rates after progestin therapy have typically been reported around 30%; however, when focusing only on those who do pursue fertility after successful treatment, the live birth rates were found to be higher than 60%. Assisted reproductive technology has been associated with a higher live birth rate compared with spontaneous conception, most likely reflecting the presence of infertility at baseline. Close follow-up is of paramount importance, and definitive treatment after completion of childbearing is advised.

AB - Endometrial cancer (EC) is the most common gynecologic malignancy in developed countries and affects predominantly postmenopausal women. It is estimated, however, that 15%-25% of women will be diagnosed before menopause. As more women choose to defer childbearing until later in life, the feasibility and safety of fertility-sparing EC management have been increasingly studied. Definitive treatment of total hysterectomy and bilateral salpingooophorectomy precludes future fertility and may thus be undesirable by women who wish to maintain their reproductive potential. However, the consideration of conservative management carries the oncologic risks of unstaged EC and the risk of missing a synchronous ovarian cancer. It is further complicated by the lack of consensus regarding the initial assessment, treatment, and surveillance. Conservative treatment with progestins has been shown to be a feasible and safe fertility-sparing approach for women with low grade, early stage EC with no myometrial invasion. The two most commonly adopted regimens are medroxyprogesterone acetate at 500-600 mg daily and megestrol acetate at 160 mg daily for a minimum of 6-9 months, with initial response rates commonly reported between 60% and 80% and recurrence rates between 25% and 40%. Photodynamic therapy and hysteroscopic EC excision have recently been reported as alternative approaches to progestin therapy alone. However, limited efficacy and safety data exist. Live birth rates after progestin therapy have typically been reported around 30%; however, when focusing only on those who do pursue fertility after successful treatment, the live birth rates were found to be higher than 60%. Assisted reproductive technology has been associated with a higher live birth rate compared with spontaneous conception, most likely reflecting the presence of infertility at baseline. Close follow-up is of paramount importance, and definitive treatment after completion of childbearing is advised.

KW - Conservative

KW - Early stage endometrial cancer

KW - Fertility sparing

KW - Levonorgestrel intrauterine device

KW - Preserving fertility

KW - Progestin

KW - Treatment

UR - http://www.scopus.com/inward/record.url?scp=84922159848&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84922159848&partnerID=8YFLogxK

U2 - 10.2147/IJWH.S47232

DO - 10.2147/IJWH.S47232

M3 - Article

AN - SCOPUS:84922159848

VL - 6

SP - 691

EP - 701

JO - International Journal of Women's Health

JF - International Journal of Women's Health

SN - 1179-1411

IS - 1

ER -