Fertility Preservation in Young Patients with Endometrial Cancer

Endometrial cancer (EC) represents the most common malignancy of the female genital tract in developed countries [1-10]. Based on recent data, the average life time risk for EC worldwide is approximately 1.71%. Although the disease mainly affects postmenopausal women, approximately 4% of patients are younger than 40 years [1-10, 12-15]. In the majority of the patients, abnormal uterine bleeding remains the most common symptom [1-7, 9, 10, 12, 13].

According to the recommendations of many international scientific societies (ACOG, FIGO, SGO, ESGO and ESMO), systematic surgical staging represents the initial treatment approach in all patients with EC [2-4, 6-10, 12, 16, 17].This is mainly because systematic surgical staging offers many diagnostic, prognostic and therapeutic benefits in these patients [2-4, 6, 8, 12, 16, 17].The extent of surgery should be carefully individualized according to the type of EC and the patient's general medical status [8].
In this light, patients younger than 40 years who wish to preserve their fertility, should be carefully counselled that fertility sparing treatment is a nonstandard approach and the available data on outcomes is limited [8,12,15,18,21].Moreover, they should be able to accept close follow-up during and after the fertility sparing treatment [8,12,19].Furthermore, they should be informed about the need of systematic surgical staging in case of treatment failure or after childbearing [8,12,15,18,19,21].
During the treatment, all patients should be evaluated with endometrial sampling (dilatation and curettage or hysteroscopy) every 3 months [8,12,15,26,32,38].After completion of the 6-month treatment, they should be further evaluated with magnetic resonance imaging in order to assess the response to the fertility sparing treatment [8,12,15,26,29,38].
On the other hand, if there is a complete response after the 6-month period, then patients should be referred to a fertility clinic in order to achieve pregnancy as soon as possible [8,12,15,[39][40][41][42]. Worth to notice that pregnancy significantly associated with a lower risk for recurrence [8,12,15,32,39].If they do not wish pregnancy at this time, they should continue the treatment with oral progestins and they should have a re-evaluation every 6 months [8,12,15,26,32,39].
In conclusion, fertility sparing treatment using progestins is a promising treatment approach for well selected young patients diagnosed with FIGO stage IA, grade 1 and type I (endometrioid) EC.Nevertheless, this management still represents a non-standard approach for them [2-4, 6-10, 12, 16, 17].In this light, all patients should be carefully informed about the effectiveness of that innovative treatment approach and the need of systematic surgical staging in case of treatment failure or after childbearing [8,12,15,20,39,43].

CONFLICT OF INTEREST
We declare that we have no conflict of interest.