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Preserving fertility in young patients with endometrial cancer: current perspectives
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...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Dove Medical Press
2014
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4122529/ https://www.ncbi.nlm.nih.gov/pubmed/25114594 http://dx.doi.org/10.2147/IJWH.S47232 |
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author | Kalogera, Eleftheria Dowdy, Sean C Bakkum-Gamez, Jamie N |
author_facet | Kalogera, Eleftheria Dowdy, Sean C Bakkum-Gamez, Jamie N |
author_sort | Kalogera, Eleftheria |
collection | PubMed |
description | 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 salpingo-oophorectomy 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. |
format | Online Article Text |
id | pubmed-4122529 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | Dove Medical Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-41225292014-08-11 Preserving fertility in young patients with endometrial cancer: current perspectives Kalogera, Eleftheria Dowdy, Sean C Bakkum-Gamez, Jamie N Int J Womens Health Review 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 salpingo-oophorectomy 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. Dove Medical Press 2014-07-29 /pmc/articles/PMC4122529/ /pubmed/25114594 http://dx.doi.org/10.2147/IJWH.S47232 Text en © 2014 Kalogera et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. |
spellingShingle | Review Kalogera, Eleftheria Dowdy, Sean C Bakkum-Gamez, Jamie N Preserving fertility in young patients with endometrial cancer: current perspectives |
title | Preserving fertility in young patients with endometrial cancer: current perspectives |
title_full | Preserving fertility in young patients with endometrial cancer: current perspectives |
title_fullStr | Preserving fertility in young patients with endometrial cancer: current perspectives |
title_full_unstemmed | Preserving fertility in young patients with endometrial cancer: current perspectives |
title_short | Preserving fertility in young patients with endometrial cancer: current perspectives |
title_sort | preserving fertility in young patients with endometrial cancer: current perspectives |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4122529/ https://www.ncbi.nlm.nih.gov/pubmed/25114594 http://dx.doi.org/10.2147/IJWH.S47232 |
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