Fertility-Sparing Treatments in Endometrial Cancer: A Comprehensive Review on Efficacy, Oncological Outcomes, and Reproductive Potential
Carlo Ronsini,
Paola Romeo,
Giada Andreoli,
Vittorio Palmara,
Marco Palumbo,
Giuseppe Caruso,
Pasquale De Franciscis,
Giuseppe Vizzielli,
Stefano Restaino,
Vito Chiantera,
Stefano Cianci
Affiliations
Carlo Ronsini
Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
Paola Romeo
Unit of Gynecology and Obstetrics, Department of Human Pathology of Adult and Childhood “G. Barresi”, University of Messina, 98121 Mesina, Italy
Giada Andreoli
Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
Vittorio Palmara
Unit of Gynecology and Obstetrics, Department of Human Pathology of Adult and Childhood “G. Barresi”, University of Messina, 98121 Mesina, Italy
Marco Palumbo
Department of General Surgery and Medical Surgical Specialties, University of Catania, 95124 Catania, Italy
Giuseppe Caruso
Department of General Surgery and Medical Surgical Specialties, University of Catania, 95124 Catania, Italy
Pasquale De Franciscis
Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
Giuseppe Vizzielli
Clinic of Obstetrics and Gynecology, “Santa Maria della Misericordia” University Hospital Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy
Stefano Restaino
Clinic of Obstetrics and Gynecology, “Santa Maria della Misericordia” University Hospital Azienda Sanitaria Universitaria Friuli Centrale, 33100 Udine, Italy
Vito Chiantera
Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
Stefano Cianci
Unit of Gynecology and Obstetrics, Department of Human Pathology of Adult and Childhood “G. Barresi”, University of Messina, 98121 Mesina, Italy
Endometrial cancer (EC) affects 3–14% of women under 40 who wish to preserve their fertility. The standard treatment for EC is a hysterectomy with salpingo-oophorectomy. However, for those desiring fertility preservation, oral progestogens such as medroxy-progesterone acetate (MPA) or megestrol acetate (MA) are the most common therapies in Fertility-Sparing Treatment (FST). Other treatments include gonadotropin-releasing hormone agonist (GnRHa), levonorgestrel-releasing intrauterine system (LNG-IUS), and metformin plus progestin. This comprehensive review evaluates the best FST options for women with reproductive potential. PubMed, EMBASE, and Scopus were searched in June 2023 using specific keywords. Studies included in the review focused on patients with EC undergoing FST, with outcomes such as complete response rate (CRR), recurrence rate (RR), pregnancy rate (PR), and live birth rate. Eighteen studies met the inclusion criteria, involving 23,976 patients. In only-oral progestin trials, CRR ranged from 18% to 100%; RR ranged from 0% to 81.8%; Death Rate ranged from 0% to 3.6%. In studies combining oral progestin with LNG-IUS, CRR ranged from 55% to 87.5%; RR ranged from 0% to 41.7%; Death Rate was 0%. Most patients with Stage IA EC received MPA or MA. Fertility-related outcomes were reported in 15 studies. PR ranged from 4 to 44 patients in trials involving only oral progestins. When combining oral progestin with LNG-IUS, PR ranged from 1 to 46 patients. Progestin therapy, including oral MPA and MA, is considered safe and effective, with limited evidence supporting the use of LNG-IUS.
