Fertility-sparing Therapy is Viable for Women with Endometrial Cancer
(ChemotherapyAdvisor) – Fertility-sparing therapy is viable for women with early-stage endometrial cancer (EC) or atypical complex endometrial hyperplasia (ACH), according to a meta-analysis published in the American Journal of Obstetrics and Gynecology.
“This study shows that young women diagnosed with early womb cancer or with its precursor (endometrial hyperplasia) can be treated conservatively with a view to maintain their fertility potential,” lead author Ioannis D. Gallos, MD, Birmingham Women's Hospital, Birmingham, UK, told Chemotherapy Advisor.
“Women can maintain their fertility and the hormonal treatment will treat successfully 76% of these women,” Dr. Gallos said.
The team pooled data from 34 observational studies to evaluate regression, relapse and live-birth rates among a total of 408 women with early-stage EC and 151 women with early-stage ACH, who were treated with the intention of sparing fertility. Fertility-sparing EC treatment was associated with a pooled regression rate of 76.2%, a relapse rate of 40.5% and a live birth rate of 28%, the authors reported. For ACH patients, fertility-sparing treatment was associated with a pooled regression rate of 85.6%, a relapse rate of 26%, and a live birth rate of 26.3%.
Treatment success “was temporary for about 40% of women who had a disease relapse,” Dr. Gallos cautioned, but “28% of women managed to deliver at least one healthy baby.”
Successful pregnancy and delivery rates were much higher – up to 50% -- with assisted reproduction.
Dr. Gallos advised caution, citing the high number of women who relapsed or experience disease progression; 3.6% of women were diagnosed with concurrent or metastatic ovarian cancer in follow-up, and 1.9% progressed beyond stage-I EC.
“It is advisable to undergo close follow-up and hysterectomy as soon as they have satisfied their reproductive wishes,” Dr. Gallos said.
“A repeat biopsy should confirm regression before women attempt to get pregnant,” the authors wrote.
“If regression is achieved we would also recommend that these women are encouraged to undertake assisted reproduction treatment in order to maximize their chances of a live birth and minimize time before a hysterectomy, which could prevent them from relapse. Immediate assisted reproduction treatment avoids prolonged unopposed estrogen stimulation, which could cause women to relapse.”
Women who decline hysterectomy should be followed for at least 5 years, they advised.