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


METHODS
Twenty-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.


RESULTS
After 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.


CONCLUSIONS
The 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.
Gynecologic Oncology Surgery, National Cancer Institute of Naples-IRCCS "Fondazione G. Pascale", Naples, Italy.|Department of Woman, Child, and General and Specialized Surgery, Second University of Naples, Naples, Italy.
Francesca
http://orcid.org/0000-0002-3729-2321
F
Falcone
Gynecologic Oncology Surgery, National Cancer Institute of Naples-IRCCS "Fondazione G. Pascale", Naples, Italy.
Giuseppe
http://orcid.org/0000-0001-6739-3687
G
Laurelli
Surgical Pathology Unit, National Cancer Institute of Naples-IRCCS "Fondazione G. Pascale", Naples, Italy.
Simona
http://orcid.org/0000-0001-9045-0328
S
Losito
Division of Medical Oncology, Department of Uro-Gynaecological Oncology, National Cancer Institute of Naples-IRCCS "Fondazione G. Pascale", Naples, Italy.
Marilena
http://orcid.org/0000-0003-4516-7341
M
Di Napoli
Radiology Unit, National Cancer Institute of Naples-IRCCS "Fondazione G. Pascale", Naples, Italy.
Vincenza
http://orcid.org/0000-0002-6601-3221
V
Granata
Gynecologic Oncology Surgery, National Cancer Institute of Naples-IRCCS "Fondazione G. Pascale", Naples, Italy. s.greggi@istitutotumori.na.it.
Stefano
http://orcid.org/0000-0001-5601-5111
S
Greggi
D000328:Adult; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D016889:Endometrial Neoplasms / Q000473:pathology / Q000628:therapy*; D005260:Female; D059247:Fertility Preservation / Q000379:methods*; D006801:Humans; D015907:Hysteroscopy; D007434:Intrauterine Devices; D016912:Levonorgestrel / Q000008:administration & dosage; D019290:Megestrol Acetate / Q000008:administration & dosage*; D011247:Pregnancy; D011372:Progestins / Q000627:therapeutic use*; D011446:Prospective Studies; D055815:Young Adult
D018931:Antineoplastic Agents, Hormonal; D011372:Progestins; D016912:Levonorgestrel; D019290:Megestrol Acetate
Endometrial Neoplasms; Fertility Preservation; Hormonal Therapy; Hysteroscopy
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