Fertility Sparing in Endometrial Cancer: Where Are We Now?
Gabriele Centini, Irene Colombi, Ilaria Ianes, Federica Perelli, Alessandro Ginetti, Alberto Cannoni, Nassir Habib, Ramon Rovira Negre, Francesco Giuseppe Martire, Diego Raimondo, Lucia Lazzeri, Errico Zupi
Author Information
Gabriele Centini: Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, 53100 Siena, Italy. ORCID
Irene Colombi: Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, 53100 Siena, Italy. ORCID
Ilaria Ianes: Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, 53100 Siena, Italy.
Alessandro Ginetti: Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, 53100 Siena, Italy. ORCID
Alberto Cannoni: Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, 53100 Siena, Italy.
Nassir Habib: Department of Obstetrics and Gynecology, Clinique de l'Yvette, 67 Route de Corbeil, 91160 Longjumeau, France. ORCID
Ramon Rovira Negre: Department of Gynecologic Oncology, Hospital de la Santa Creu i de Sant Pau, 08025 Barcelona, Spain. ORCID
Francesco Giuseppe Martire: Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, 53100 Siena, Italy. ORCID
Diego Raimondo: Division of Gynaecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero Univeristaria di Bologna, 40138 Bologna, Italy. ORCID
Lucia Lazzeri: Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, 53100 Siena, Italy. ORCID
Errico Zupi: Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, 53100 Siena, Italy. ORCID
Endometrial Cancer is the most common gynecological neoplasm with an increased incidence in the premenopausal population in recent decades. This raises the problem of managing Endometrial Cancer in fertile women who have not yet achieved pregnancy. In these women, after careful selection, hysterectomy may be postponed in favor of conservative management if specific requirements are met. The latest evidence is focused on early endometrial carcinoma, endometrioid histotype, Grading 1, with no evidence of myometrial infiltration. Few clinical trials have opened this possibility also for women with an Endometrial Cancer Grading 2 diagnosis. There are still questions about the best medical therapy, dosage, route, and duration of treatment. Oral progestins or levonorgestrel-releasing intrauterine devices appear to be the options associated with the best outcome in terms of complete response and lower recurrence rates. Other options include the use of GnRH analogues, surgical hysteroscopy, or metformin, in a therapeutic approach that takes into account the characteristics of the patient. The pursuit of pregnancy should start as soon as two consecutive endometrial biopsies are obtained 3 months apart from each other; it is recommended to refer the patients to ART centers to maximize the success rate. After having reached the fulfillment of the reproductive desire, surgical radical treatment is still recommended.
