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Fertility-sparing treatment in early endometrial cancer: current state and future strategies

Andreas Obermair|Eva Baxter|Donal J. Brennan|Jessica N. McAlpine|Jennifer J. Mueller|Frédéric Amant|Mignon D. J. M. van Gent|Robert L. Coleman|Shannon N. Westin|Melinda S. Yates|Camilla Krakstad|Monika Janda
대한산부인과학회 (Korean Soceity of Obstetrics and Gynecology)|2020.07|Obstetrics & Gynecology Science|제63권 제4호|pp. 417-431|DOI 10.5468/ogs.19169

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참고문헌

키워드

Conservative treatmentProgestinFertility preservationEndometrial cancer
주제분류산부인과학

초록

Endometrial cancer (EC) is the fifth most common cancer in women worldwide. Global estimates show risingincidence rates in both developed and developing countries. Most women are diagnosed postmenopausal, but14–25% of patients are premenopausal and 5% are under 40 years of age. Established risk factors include age andhyperestrogenic status associated with nulliparity, obesity, and metabolic syndrome. Standard treatment for EC,which involves total hysterectomy and bilateral salpingo-oophorectomy, has excellent survival outcomes, particularlyfor low-grade endometrioid tumors. However, it leads to permanent loss of fertility among women who wish topreserve their reproductive potential. With current trends of reproductive-age women delaying childbearing, risingEC incidence rates, and a growing epidemic of obesity, particularly in developed countries, research on conservativenon-surgical treatment approaches remains a top priority. Fertility-sparing treatment predominantly involves theuse of oral progestins and levonorgestrel-releasing intrauterine devices, which have been shown to be feasible andsafe in women with early stage EC and minimal or no myometrial invasion. However, data on the efficacy and safetyof conservative management strategies are primarily based on retrospective studies. Randomized clinical trials inyounger women and high-risk obese patients are currently underway. Here, we have presented a comprehensivereview of the current literature on conservative, fertility-sparing approaches, defining the optimal candidates andevaluating tumor characteristics, reproductive and oncologic outcomes, and ongoing clinical trials. We have alsosummarized current guidelines and recommendations based on the published literature.

Abstract

Endometrial cancer (EC) is the fifth most common cancer in women worldwide. Global estimates show risingincidence rates in both developed and developing countries. Most women are diagnosed postmenopausal, but14–25% of patients are premenopausal and 5% are under 40 years of age. Established risk factors include age andhyperestrogenic status associated with nulliparity, obesity, and metabolic syndrome. Standard treatment for EC,which involves total hysterectomy and bilateral salpingo-oophorectomy, has excellent survival outcomes, particularlyfor low-grade endometrioid tumors. However, it leads to permanent loss of fertility among women who wish topreserve their reproductive potential. With current trends of reproductive-age women delaying childbearing, risingEC incidence rates, and a growing epidemic of obesity, particularly in developed countries, research on conservativenon-surgical treatment approaches remains a top priority. Fertility-sparing treatment predominantly involves theuse of oral progestins and levonorgestrel-releasing intrauterine devices, which have been shown to be feasible andsafe in women with early stage EC and minimal or no myometrial invasion. However, data on the efficacy and safetyof conservative management strategies are primarily based on retrospective studies. Randomized clinical trials inyounger women and high-risk obese patients are currently underway. Here, we have presented a comprehensivereview of the current literature on conservative, fertility-sparing approaches, defining the optimal candidates andevaluating tumor characteristics, reproductive and oncologic outcomes, and ongoing clinical trials. We have alsosummarized current guidelines and recommendations based on the published literature.

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