Conservative surgical management of stage IA endometrial carcinoma for fertility preservation

Objective

To describe an innovative method to preserve fertility in young women with stage IA endometrial cancer with use of hysteroscopic resection followed by administration of 160 mg of megestrol acetate.

Design

Prospective study.

Setting

Division of Gynecologic Oncology, Catholic University of the Sacred Heart, and the Endoscopic Gynecologic Unit, Nuova Villa Claudia, Rome, Italy.

Patient(s)

Six young patients with stage IA endometrial cancer.

Intervention(s)

Conservative resectoscopic treatment using a three-step technique in which each step is characterized by a pathologic analysis: the removal of the tumor (step 1), the removal of the endometrium adjacent to the tumor (step 2), and the removal of the myometrium underlying the tumor (step 3).

Main Outcome Measure(s)

Therapy of stage IA endometrial cancer and pregnancy.

Result(s)

The conservative surgery was effective because results of transvaginal ultrasound examination and diagnostic hysteroscopy with target biopsies at 3, 6, 9, and 12 months after surgery were negative for atypia or malignancy. Moreover, four out of six patients (66%) achieved childbearing.

Conclusion(s)

This method, under a close postsurgical follow-up, might represent a novel therapeutic option for those women with stage IA endometrial cancer who wish to preserve fertility.

Key Words: Endometrial cancer, fertility preservation, hysteroscopy, hormone therapy