Conservative management of grade 2 stage IA endometrial carcinoma and literature review

Abstract

Purpose To explore the clinical outcomes of megestrol acetate alone or plus metformin in young women with grade 2 stage IA endometrial carcinoma who ask for preserved fertility. Methods Patients with stage IA grade 2 endometrial carcinoma who asked for fertility‐sparing treatment in the Obstetrics and Gynecology Hospital of Fudan University between 2015 and 2017 were enrolled and retrospectively reviewed. Results Four patients were included and treated with oral megestrol acetate (160 mg per day), while metformin (500 mg, thrice daily) was added for patients with metabolic syndrome. Regular hysteroscopic examination was performed every 3 months during the conservative treatment. Overall, 75% (3/4) of the patients had a complete response, one relapsed and achieved a complete response after changing the therapy plan, and one patient had an indication of myometrial invasion during fertility‐sparing treatment and chose to remove uterus. Conclusions Fertility‐sparing treatment for stage IA grade 2 endometrial carcinoma patients is worth exploration. Megestrol acetate with or without metformin combined with hysteroscopic lesion ablation may be an effective therapy.

Hysteroscopic Curettage Followed by Megestrol Acetate Plus Metformin as a Fertility-Sparing Treatment for Women with Atypical Endometrial Hyperplasia or Well-Differentiated Endometrioid Endometrial Carcinoma

“… 19 As the need to preserve fertility increased, several studies attempted to broaden the indications for conservative management. 4 , 20 - 22 Growing literature reported that hormonal treatment was safe and feasible in stage IA G2 EC. 4 , 20 - 22 So far, the largest series of stage IA G2 EC cohorts receiving conservative treatment was reported by Falcone et al 4 By adopting systemic or local progestins (74% combined with hysteroscopic resection), they achieved a CR rate of 73.9%, a relapse rate of 41.1%, and a live birth rate of 17.6%.…”

“… 4 , 20 - 22 Growing literature reported that hormonal treatment was safe and feasible in stage IA G2 EC. 4 , 20 - 22 So far, the largest series of stage IA G2 EC cohorts receiving conservative treatment was reported by Falcone et al 4 By adopting systemic or local progestins (74% combined with hysteroscopic resection), they achieved a CR rate of 73.9%, a relapse rate of 41.1%, and a live birth rate of 17.6%. 4 Two studies conducted in China also reported CR rates of 87.5% (7/8) and 75% (3/4) with recurrence rates of 42.8% (3/7) and 33.3% (1/3), respectively.…”

“… 20 , 21 Concerning a pooled CR rate beyond 70% and an overall good prognosis despite treatment response, conservative treatment is at least a worth-trying option for presumed stage IA G2 ECC who strongly wish to have a baby. 4 , 20 , 21 …”

Fertility-sparing treatment of endometrial cancer - is it possible? A case study

“…Fertility-sparing treatments should be considered in patients with atypical hyperplasia or endometrioid intra-epithelial neoplasia or grade 1 endometrioid carcinoma without myometrial invasion and without genetic risk factors [ESMO]. Only a few studies have reported results of fertility-sparing treatment in patients with more advanced disease [12][13][14] [15][16] [17].…”

Less is more in endometrial cancer (SLN, conservative treatment, radical hysterectomy, molecular classification)

“…Where the safety of fertility preservation is well documented in grade 1 endometrioid endometrial cancer not invading the myometrium as determined by magnetic resonance imaging [33], few studies focused on the safety of fertility-sparing management for grades 2 and 3 endometrial cancer and reported conflicting results [34][35][36][37]. It is therefore suggested that such management should be limited in time.…”