Fertility-sparing treatments for patients with endometrial cancer: A comprehensive review

Endometrial cancer (EC) in young women is relatively likely to be early-stage, low-grade, and without risk factors. Fertility-sparing treatment with progestin is a potential primary approach for certain patients. However, several factors should be considered according to available guidelines. The potential indication for fertility-sparing treatment in patients with EC, as recommended by various societies of gynecologic oncology, includes young women with grade 1 endometrioid adenocarcinoma confined to the endometrium. Magnetic resonance imaging should be performed to rule out myometrial invasion and extrauterine disease before initiating fertility-sparing treatment. Other imaging modalities may also be used to exclude extrauterine disease. Various fertility-sparing therapies exist, the most common of which is high-dose oral progestin. After initiating fertility-sparing treatment, pathological re-evaluation of the endometrium at 3 to 6 months is recommended. The optimal duration of fertility-sparing treatment is up to 15 months, but guidelines recommend continuing progestin therapy until attempting conception. Ovarian stimulation drugs used for pregnancy are considered safe after a complete response is achieved. Hysterectomy is recommended after childbearing, while oophorectomy is not mandatory for young women. Close surveillance should continue for women who do not wish to undergo surgery after childbirth. Based on existing evidence, fertility-preserving treatments have demonstrated effectiveness and do not appear to negatively impact prognosis. If a qualified patient expresses a strong desire for fertility preservation despite the potential for recurrence, the physician should consider fertility-sparing treatment while maintaining vigilant monitoring.