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Archives of Gynecology and Obstetrics

, Volume 298, Issue 2, pp 373–380 | Cite as

Conservative management of endometrial cancer: a survey amongst European clinicians

  • M. La Russa
  • I. Zapardiel
  • M. J. Halaska
  • K. Zalewski
  • R. Laky
  • P. Dursun
  • D. Lindquist
  • V. Sukhin
  • S. Polterauer
  • I. Biliatis
Gynecologic Oncology
  • 104 Downloads

Abstract

Objective

To investigate differences and similarities in the clinical approach of young clinicians managing women with endometrial cancer (EC) conservatively.

Methods

A web-based survey was carried out. A platform of the European Network of Young Gynaecological Oncologists (ENYGO) database was used. A 38-item multiple-choice questionnaire was used to evaluate current practice in fertility-sparing management of EC. The survey covered investigations, treatment options, follow-up and management of recurrence and future family planning. Descriptive statistics were used.

Results

Overall, 116 out of 650 (17.84%) ENYGO members responded to the survey. In 92 (79.3%) centres, the caseload of early stage EC treated conservatively was less than 10 per year. One hundred and seven responders (93.8%) believe that treatment with progestins could be offered in grade 1 EC without myometrial invasion, but a minority would recommend it even for grade 2 tumours with no myometrial invasion or grade 1 with superficial invasion. The diagnostic tool for establishing grade of tumour was hysteroscopy with dilatation and curettage in 64 (55%) centres. Medroxyprogesterone acetate represents the most commonly prescribed progestogen (55, 47.4%). In 78 (67.2%) centres, a repeat endometrial biopsy was offered after 3 months of treatment commencement. Recurrences are treated mostly with hysterectomy (81, 69.9%) with only a small number of responders recommending to repeat progestin treatment. Lynch syndrome is a contraindication for conservative management in half of the responders (57, 49.1%). Most clinicians agree that patients should be referred promptly for assisted reproductive techniques once complete response has been achieved (68, 58.6%).

Conclusions

Our study shows that conservative management is increasingly offered to women affected by early stage EC wishing to preserve their fertility. Further studies and joint registries are required to evaluate safety and effectiveness of this approach in this probably growing number of patients.

Keywords

Endometrial cancer Conservative management Progestins Assisted reproduction Pregnancies 

Notes

Author contributions

MR: manuscript writing, protocol development, and data analysis. IZ: manuscript editing, protocol development, and data analysis. MJH: manuscript editing, protocol development, and data analysis. KZ: manuscript editing and data analysis. RL: manuscript editing and data collection. PD: manuscript editing and data collection. DL: manuscript editing and data collection. VS: manuscript editing and data collection. SP: manuscript editing and data collection. IB: manuscript writing/editing, protocol development, and data analysis

Funding

The study was funded by Charles University research project Progress Q-28 Oncology (MJH).

Compliance with ethical standards

Conflict of interest

Signed disclosure is added in a separate file, and there is no conflict of interest.

Informed consent

Informed consent is not needed, as it is an original research based on a questionnaire.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • M. La Russa
    • 1
  • I. Zapardiel
    • 2
  • M. J. Halaska
    • 3
  • K. Zalewski
    • 4
    • 5
    • 6
  • R. Laky
    • 7
  • P. Dursun
    • 8
  • D. Lindquist
    • 9
  • V. Sukhin
    • 10
  • S. Polterauer
    • 11
  • I. Biliatis
    • 12
  1. 1.Department of Gynecological Oncology, Norfolk and Norwich University HospitalNHS TrustNorwichUK
  2. 2.Gynecologic Oncology Unit, La Paz University HospitalIdiPAZMadridSpain
  3. 3.Department of Obstetrics and Gynaecology, 3rd Medical FacultyCharles University Prague, Faculty Hospital Kralovske VinohradyPragueCzech Republic
  4. 4.Department of Gynecologic OncologyHolycross Cancer CenterKielcePoland
  5. 5.Department of Obstetrics, Gynecology and Oncology, 2nd Faculty of MedicineWarsaw Medical UniversityWarsawPoland
  6. 6.Department of Molecular and Translational OncologyMaria Sklodowska-Curie Memorial Cancer Center, Institute of OncologyWarsawPoland
  7. 7.Division of GynecologyMedical University GrazGrazAustria
  8. 8.Department of Obstetrics and GynecologyBaskent University School of MedicineAnkaraTurkey
  9. 9.Department of Radiation SciencesUmeå UniversityUmeåSweden
  10. 10.Department of OncogynecologyGrigoriev Institute for Medical RadiologyKharkivUkraine
  11. 11.Department of Gynecology and Gynecologic OncologyMedical University of ViennaViennaAustria
  12. 12.Department Gynecological OncologyPoole NHS TrustPooleUK

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