1
|
Lago V, Marina T, Laseca Modrego M, Gil-Ibañez B, Rodriguez JR, Domingo J, Minig L, Padilla-Iserte P, Arencibia Sánchez O, Sala Ferichola M, Munmanny M, Martín Salamanca B, Iacoponi S, Cabrera S, Coronado P, Utrilla-Layna J, Bataller Á, Fiol G, Corbalán S, Espinosa E, Gil-Moreno A, Domingo S. Fertility sparing treatment in patients with endometrial cancer (FERT-ENC): a multicentric retrospective study from the Spanish Investigational Network Gynecologic Oncology Group (SPAIN-GOG). Arch Gynecol Obstet 2022; 306:821-828. [PMID: 35122158 DOI: 10.1007/s00404-021-06375-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 12/20/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The primary objective was to evaluate the response rate of conservative treatment for endometrial cancer, and the secondary objective was to assess oncological, fertility and obstetric outcomes in patients who underwent fertility preservation treatment. MATERIAL AND METHODS This multicentre, observational, retrospective study evaluated endometrial cancer patients who underwent fertility-sparing treatment in Spanish centres between January 2010 and January 2020. Seventy-three patients with stage IA endometrioid adenocarcinoma of the uterus were included in the study. RESULTS The levonorgestrel intrauterine device (LNG-IUD) was the most common fertility-sparing treatment (53.4%), followed by megestrol acetate (20.5%) and medroxyprogesterone acetate (16.4%). During the 24-month follow-up period, the rate of complete response to fertility-sparing management was 74% (n = 54), and 8.2% (n = 6) of patients presented a partial response. Additionally, 13 (17.8%) patients presented with persistent disease and six (8.2%) relapsed after response. The LNG-IUD was associated with a higher complete response rate than the other methods (87.2 vs. 58.8%; p = 0.01). Surgical treatment (at least hysterectomy) was performed in 44 (60.3%) patients as the end of fertility-sparing treatment. Four (5.5%) patients presented relapse after surgery, associated with final FIGO stage III (p = 0.036), myometrial invasion > 50% (p = 0.018) and final tumour grade 2-3 (p = 0.018). The mean follow-up period was 57.8 (range 6-159) months. The 5-year relapse-free survival and overall survival rates were 92.6% [95% CI (81.3, 97.2)] and 93.5% [95% CI (80.7, 97.9)], respectively. During follow-up, three patients (4.1%) died of the disease after completion of surgical treatment. Up to 50.7% of patients included in the study attempted to get pregnant. Of these, the rate of pregnancy was 81.1% (n = 30/37), and reproductive techniques were used for this purpose in 78.4% of cases. CONCLUSIONS Fertility-sparing management presented a high response rate in patients with endometrial cancer. LNG-IUD was associated with a better response rate compared to the other treatment options. Moreover, in patients using this management method, pregnancy could be achieved using reproductive techniques.
Collapse
Affiliation(s)
- Víctor Lago
- Gynecologic Oncology Department, University Hospital La Fe, Valencia, Spain.
| | - Tiermes Marina
- Gynecologic Oncology Department, University Hospital La Fe, Valencia, Spain.,Obstetrics and Gynecology Department, Clinic University Hospital, Barcelona, Spain
| | - María Laseca Modrego
- Gynecologic Oncology Department, Maternal and Child University Hospital of the Canarias, Canari Island, Spain
| | - Blanca Gil-Ibañez
- Gynecologic Oncology Department, University Hospital, 12 de Octubre, Madrid, Spain
| | - José Ramón Rodriguez
- Obstetrics and Gynecology Department, Clinic and University Hospital Virgen de la Arrixaca, Murcia, Spain
| | | | - Lucas Minig
- Department of Gynecology, CEU Cardenal Herrera University, Valencia, Spain
| | | | - Octavio Arencibia Sánchez
- Gynecologic Oncology Department, Maternal and Child University Hospital of the Canarias, Canari Island, Spain
| | - Manuela Sala Ferichola
- Obstetrics and Gynecology Department, General University Hospital of Alicante, Alicante, Spain
| | - Merixell Munmanny
- Obstetrics and Gynecology Department, Clinic University Hospital, Barcelona, Spain
| | | | - Sara Iacoponi
- Gynecologic Oncology Department, Hospital Quironsalud Madrid, Madrid, Spain
| | - Silvia Cabrera
- Gynecologic Oncology Department, University Hospital Vall d´Hebron, Barcelona, Spain
| | - Pluvio Coronado
- Obstetrics and Gynecology Department, Clinic University Hospital San Carlos, Madrid, Spain
| | | | - Águeda Bataller
- Obstetrics and Gynecology Department, University Hospital of La Rivera, Alzira, Spain
| | - Gabriel Fiol
- Gynecologic Oncology Department, University Hospital Torrecárdenas, Almeria, Spain
| | - Shiana Corbalán
- Obstetrics and Gynecology Department, University Hospital Los Arcos, Murcia, Spain
| | | | - Antonio Gil-Moreno
- Gynecologic Oncology Department, University Hospital Vall d´Hebron, Barcelona, Spain
| | - Santiago Domingo
- Gynecologic Oncology Department, University Hospital La Fe, Valencia, Spain
| | | |
Collapse
|