Fertility-preserving treatment of stage IA, well-differentiated endometrial carcinoma (EC) or atypical complex hyperplasia (ACH) in young women with hysteroscopic resection and high-dose progesterone therapy

Background The standard treatment for endometrial cancer is surgery with hysterectomy. However, this procedure will cause infertility in young women who desire fertility preservation. The aim of this study was to examine the effectiveness of conservative therapy with high-dose progesterone therapy and local hysteroscopic resection in large clinical university centers in Germany.

Methods Patients treated for EC or ACH at the large clinical university Women´s hospitals between 2006 and 2018 in Germany were identified. All available data on conservative and surgical treatment, recurrence, overall survival and pregnancy were recorded retrospectively and statistically evaluated.

Results A total of 41 patients were identified. 3 with ACH and 38 with EC Stage IA, 2 of them showed G2- and 36 G1-carcinoma. 3 patients underwent local hysteroscopic resection and then high-dose progesterone therapy. The remaining patients received diagnostic curettage with subsequent high-dose progesterone therapy and control biopsies intrauterine every 3-6 months. The median follow-up was 48.6 months. The recurrence occurred in 8/41 (19.5 %) cases. There were 6 pregnancies (14.6 %) with IVF treatment with 4 successful births and 2 missed abortion. 8/41 (19.5 %) underwent the definite surgery. EC residues were found in 7/8 (87.5 %) cases and ACH in 1/8 (12.5 %) case. The complete remission occurred in 15/41 (36.7 %) cases.

Conclusion Fertility-sparing treatment of patients with EC/ACH is a possible therapy option. The treatment methods are currently very inhomogeneous and a standardized protocol must be established. Large multicenter data registers and studies are required to confirm the treatment-protocol.

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Artikel online veröffentlicht:
07. Oktober 2020