Hysteroscopic Resection in Fertility-Sparing Surgery for Atypical Hyperplasia and Endometrial Cancer: Safety and Efficacy

Marzi, Patrizia De; Bergamini, Alice; Luchini, Stefania; Petrone, Micaela; Taccagni, G; Mangili, Giorgia; Colombo, Gabriella; Candiani, Massimo

doi:10.1016/j.jmig.2015.06.004

Cited by 47 publications

(37 citation statements)

References 18 publications

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“…Overall, the recurrence rate observed in our study (7.7%) as well as in the studies of combined HR and progestins (16%) seems to be lower (Table 4) [789101112] than that reported after progestin therapy alone (32%) (Table 5) [293233343536]. Although such comparisons are not methodologically correct, it may be argued that the hysteroscopic tumor resection gives some additional benefit.…”

Section: Discussioncontrasting

confidence: 61%

“…This is the largest series of EC treated by such a combined approach, and that with the longest follow-up published so far (Table 4) [789101112]. In our experience, this strategy, in young women with intramucous G1 EC, resulted in a complete regression rate of 96.3% (26/27), with a recurrence rate of 7.7% (2/26).…”

Section: Discussionmentioning

confidence: 63%

“…The 96.3% complete regression rate observed in our G1 patients suggests that the addition of a standardized three-step resectoscopy may improve the efficacy of progestin alone, maximizing the likelihood of a durable disease regression. The overall 93.3% (range, 78% to 100%) complete regression rate, observed in the studies on combined HR and progestin therapy (Table 4) [789101112], seems to be higher than that reported in the most recent series including progestin therapy alone (77% [range, 43% to 78%]) (Table 5) [293233343536]. The potential late risks of additional HR may consist of intrauterine adhesions and uterine rupture during pregnancy.…”

Section: Discussionmentioning

confidence: 88%

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Fertility preserving treatment with hysteroscopic resection followed by progestin therapy in young women with early endometrial cancer

et al. 2017

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ObjectiveTo report our 15-year institutional experience of fertility-sparing treatment in young patients with early endometrial cancer (EC) treated by combined hysteroscopic resection and progestin therapy.MethodsTwenty-eight patients (stage IA, G1 and 2 endometrioid EC) wishing to preserve their fertility were enrolled into this prospective study. Hysteroscopic resection was used to resect the tumor, endometrium adjacent to the tumor and myometrium underlying the tumor. Adjuvant hormonal therapy consisted of oral megestrol acetate or levonorgestrel intrauterine device for 6 months or more.ResultsAfter 3 months from the progestin start date, 25 patients (89.3%) showed a complete regression (median time to complete regression, 3 months [range, 3-9 months]), two (7.1%) showed persistent disease, while one patient (3.6%) presented with progressive disease and underwent definitive surgery (stage IA, G3 endometrioid). At 6 months, one of the two patients with persistent disease underwent definitive surgery (stage IA, G1 endometrioid), while the other one was successfully re-treated. Two recurrences were observed (7.7%) both involving the endometrium and synchronous ovarian cancer. The median duration of complete response was 94.5 months (range, 8-175 months). More than half of the responders (57.7%) attempted to conceive with 93.3% and 86.6% pregnancy and live birth rates, respectively.ConclusionThe addition of a standardized three-step resectoscopy to progestin would seem to improve the efficacy of progestin alone. High pregnancy and live birth rates were observed in women attempting to conceive.

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Section: Discussioncontrasting

confidence: 61%

Section: Discussionmentioning

confidence: 63%

Section: Discussionmentioning

confidence: 88%

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Fertility preserving treatment with hysteroscopic resection followed by progestin therapy in young women with early endometrial cancer

et al. 2017

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“…Among these 14 studies, 7 only used MPA or MA as FST (3, 7, 15, 19–22) and 2 combined GnRH agonist and LNG-IUD (6, 23) whereas 5 used hysteroscopic resection combined to high-dose oral progestin (2, 4, 5, 24, 25). As far as we know, no other study [except Jadoul and Donnez (11)] reported the effect of GnRH agonist combined with hysteroscopic endometrium resection as FST for EIN or EC.…”

Section: Discussionmentioning

confidence: 99%

“…Adding endometrium resection to the hormonal treatment increases the risk of intrauterine adhesion, which represents the major long-term complication of operative hysteroscopic procedures, with an incidence that varies according to type and extension of surgery, surgical indication and patient's age (24). In order to keep a maximum of normal endometrium to allow pregnancy, the endometrium resection must not be too deep in the normal-looking part of the cavity (blind biopsies) and a complete resection must be limited to the macroscopically abnormal endometrium.…”

Section: Discussionmentioning

confidence: 99%

Fertility Sparing Treatment in Patients With Early Stage Endometrial Cancer, Using a Combination of Surgery and GnRH Agonist: A Monocentric Retrospective Study and Review of the Literature

et al. 2018

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Objectives: To evaluate the efficacy and safety of gonadotropin-releasing hormone (GnRH) agonist after endometrial resection in women suffering early stage endometrial carcinoma (EC) and/or endometrial intra-epithelial neoplasia (EIN).Design: A retrospective review of clinical files between January 1999 and December 2016.Setting: University hospital.Patients: Eighteen women younger than 41 years with grade 1 endometrial carcinoma (G1EC) and/or Endometrial intra-epithelial neoplasia (EIN). Interventions: All patients received GnRH agonist for 3 months after an endometrial resection combined with a laparoscopy to exclude concomitant ovarian tumor and/or other extra-uterine disease. The patient underwent a follow-up of 3 months interval with endometrial sampling by hysteroscopy.Main Outcome Measure(s): The recurrence rate and the pregnancy rate after fertility sparing treatment.Results: We identified 9 patients with EIN (50%), 7 patients with G1EC (38.9%), 1 with combined histology (5.5%), and 1 with G2EC (5.5%). After a median follow-up of 40.7 months, 12 patients conserved their uterus (66.7%), and 8 (53.3%) patients were pregnant with a total of 14 pregnancies among those who tried to become pregnant. We observed a complete response rate in 12 patients (66.7%) but 3 of these patients relapsed (25%). We also found a stable disease in 6 patients (33.3%).Conclusions: Compared with other fertility sparing treatments, GnRH agonist after surgery is an effective fertility-sparing strategy for women with EIN and/or G1EC. We recommend hysterectomy once a family has been completed even if the literature does not clearly lead to radical surgery.

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A systematic review and meta‐analysis of prognostic factors for remission in fertility‐sparing management of endometrial atypical hyperplasia and adenocarcinoma

Guillon

Popescu

Phelippeau

et al. 2019

Intl J Gynecology & Obste

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Background: Endometrial cancer and atypical hyperplasia are rare in young women but create a dilemma between desire for pregnancy and oncologic outcomes.Objective: To identify remission rates and associated prognostic factors in patients undergoing fertility-sparing management for endometrial cancer and atypical hyperplasia. Search strategy: MEDLINE was searched for studies published between January 1, 1950 and July 31, 2017 using various search terms. Selection criteria: Studies evaluating fertility-sparing management in patients aged between 19 and 44 years with atypical hyperplasia or stage I endometrial cancer. Data collection and analysis: Use of PRISMA guidelines to conduct a meta-analysis of the proportion of patients in remission and meta-regression analysis to test the effect of possible prognostic factors for remission.Main results: A total of 3673 studies were screened; 65 studies including 1604 patients met the inclusion criteria. The remission rate was 0.75 (95% CI, 0.73-0.77).Operative hysteroscopy for endometrial sampling was associated with higher remission rates (OR 2.31; 95% CI, 1.10-4.84; P=0.03). Studies with higher ratios of infertile women were associated with higher remission rates (OR 4.21; 95% CI, 1.44-12.33; P<0.01). Conclusion:Operative hysteroscopy is the preferred endometrial sampling method for patients with atypical hyperplasia or endometrial cancer undergoing fertilitysparing management.

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Hysteroscopic Resection in Fertility-Sparing Surgery for Atypical Hyperplasia and Endometrial Cancer: Safety and Efficacy

Cited by 47 publications

References 18 publications

Fertility preserving treatment with hysteroscopic resection followed by progestin therapy in young women with early endometrial cancer

Fertility preserving treatment with hysteroscopic resection followed by progestin therapy in young women with early endometrial cancer

Fertility Sparing Treatment in Patients With Early Stage Endometrial Cancer, Using a Combination of Surgery and GnRH Agonist: A Monocentric Retrospective Study and Review of the Literature

A systematic review and meta‐analysis of prognostic factors for remission in fertility‐sparing management of endometrial atypical hyperplasia and adenocarcinoma

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