Fertility-Sparing Treatment of Endometrial Cancer: Survey of Australian Practice

Endometrial cancer is the most common gynaecological malignancy in Australia. Patients diagnosed in their reproductive window may desire a fertility-sparing approach, opposed to standard surgical care. International guidelines on fertility-sparing management exist; however, these highlight the lack of high-level evidence to support the recommendations. There are no Australian-specific guidelines or registries, leading to uncertainty as to how patients are managed locally.

To survey clinicians in Australia regarding fertility-sparing management of endometrial cancer, to identify areas of consensus and variation, barriers to care and research priorities.

A 47-item online survey was distributed to clinicians who manage patients with endometrial cancer in Australia between November 2024 and January 2025. Responses were analysed descriptively.

Of 70 eligible clinicians, 56% responded. There was agreement on appropriate candidate selection for FIGO grade 1 disease with absent/focal myoinvasion, use of hysteroscopy for diagnosis, and preference for levonorgestrel intra-uterine device as initial therapy. Opinions were divided on management of patients with Lynch syndrome or more extensive myoinvasion, the diagnostic utility of endometrial pipelle, and treatment of recurrences. POLE mutation testing and hysteroscopic resection were uncommon practices. Most respondents referred patients to fertility specialists, while other members of the multi-disciplinary team were less frequently utilised. The most frequent research priorities were weight-loss strategies (31%) and molecular profiling (27%).

Clinicians in Australia have common approaches to diagnosis and first-line therapy, but there is variation in patient selection, surveillance and engagement with a multi-disciplinary team. These discrepancies highlight the potential benefits of local guidelines and further research.