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Conservative management of endometrial cancer: a survey amongst European clinicians

Archives of Gynecology and Obstetrics volume 298, pages 373–380 (2018)Cite this article

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.

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References

  1. Cancer Research UK. http://www.cancerresearchuk.org/cancer-info/cancerstats/incidence/commoncancers/#Twenty. Accessed Jan 14 2014

  2. Lee NK, Cheung MK, Shin JY et al (2007) Prognostic factors for uterine cancer in reproductive-aged women. Obstet Gynecol 109:655–662

    Article  PubMed  Google Scholar 

  3. Surveillance, Epidemiology and End Result programme. https://seer.cancer.gov/statfacts/html/corp.html. Accesed Apr 2 2017

  4. Garg K, Soslow RA (2014) Endometrial carcinoma in women aged 40 years and younger. Arch Pathol Lab Med 138:335–342

    Article  PubMed  Google Scholar 

  5. World Cancer Research Fund/American Institute for Cancer Research (2013). Continuous Update Project Report. Food, Nutrition, Physical Activity, and the Prevention of Endometrial Cancer. https://www.wcrf.org/int/continuous-update-project

  6. Zhang Y, Liu H, Yang S et al (2014) Overweight, obesity and endometrial cancer risk: results from a systematic review and meta-analysis. Int J Biol Markers 29:e21–e29

    Article  PubMed  Google Scholar 

  7. Fader AN, Arriba LN, Frasure HE et al (2009) Endometrial cancer and obesity: epidemiology, biomarkers, prevention and survivorship. Gynecol Oncol 114(1):121–127

    Article  PubMed  Google Scholar 

  8. Esposito K, Chiodini P, Capuano A et al (2014) Metabolic syndrome and endometrial cancer: a meta-analysis. Endocrine 45:28–36

    Article  PubMed  CAS  Google Scholar 

  9. Cancer Research UK. http://www.cancerresearchuk.org/cancer-info/cancerstats/incidence/commoncancers/#Twenty. Accessed Jan 14 2014

  10. National Cancer Institute. Endometrial cancer treatment Physician Data Query (PDQ).2015;http://www.cancer.gov/cancertopics/pdq/treatment/endometrial/healthprofessional. Accessed 1 Apr 2015

  11. Gallos ID, Yap J, Rajkhowa M et al (2012) Regression, relapse, and live birth rates with fertility-sparing therapy for endometrialcancer and atypical complex endometrial hyperplasia: a systematic review and metaanalysis. Am J Obstet Gynecol 207(4):266.e1–12

    Article  PubMed  Google Scholar 

  12. Rodolakis A, Biliatis I, Morice P et al (2015) European Society of Gynecological Oncology Task Force for Fertility Preservation: Clinical Recommendations for Fertility-Sparing Management in Young Endometrial Cancer Patients. Int J Gynecol Cancer 25:1258–1265

    Article  PubMed  Google Scholar 

  13. Colombo N, Creutzberg C, Amant F, ESMO-ESGO-ESTRO Endometrial Consensus Conference Working Group et al (2016) ESMO-ESGO-ESTRO consensus conference on endometrial cancer: diagnosis, treatment and follow-up. Int J Gynecol Cancer 26(1):2–30

    Article  PubMed  Google Scholar 

  14. Choi HJ, Lee S, Park BK et al (2016) Long-term outcomes of magnetic resonance imaging-invisible endometrial cancer. J Gynecol Oncol 27(4):e38

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  15. Woo S, Kim SY, Cho JY et al (2017) Assessment of deep myometrial invasion of endometrial cancer on MRI: added value of second-opinion interpretations by radiologists subspecialized in gynaecologic oncology. Eur Radiol 27(5):1877–1882

    Article  PubMed  Google Scholar 

  16. Kaku T, Tsurichi N, Tsukamoto N et al (1994) Reassessment of myometrial invasion in endometrial carcinoma. Obstet Gynecol 84:979–982

    PubMed  CAS  Google Scholar 

  17. Ushijima K, Yahata H, Yoshikawa H, et al. Multicenter phase II study of fertility-sparing treatment with medroxyprogesterone acetate for endometrial

  18. Park JY, Kim DY, Kim JH et al (2013) Long-term oncologic outcomes after fertility-sparing management using oral progestin for young women with endometrial cancer (KGOG 2002). Eur J Cancer 49(4):868–874

    Article  PubMed  CAS  Google Scholar 

  19. Koskas M, Uzan J, Luton D et al (2014) Prognostic factors of oncologic and reproductive outcomes in fertility-sparing management of endometrial atypical hyperplasia and adenocarcinoma: systematic review and meta-analysis. Fertil Steril 101(3):785–794

    Article  PubMed  Google Scholar 

  20. Park JY, Lee SH, Seong SJ et al (2013) Progestin re-treatment in patients with recurrent endometrial adenocarcinoma after successful fertility-sparing management using progestin. Gynecol Oncol 129:4–8

    Article  CAS  Google Scholar 

  21. Perri T, Korach J, Gotlieb WH et al (2011) Prolonged conservative treatment of EC patients: more than 1 pregnancy can be achieved. Int J Gynecol Cancer 21:728

    Article  Google Scholar 

  22. Matsuo K, Machida H, Shoupe D et al (2016) Ovarian conservation and overall survival in young women with early-stage low-grade endometrial cancer. Obstet Gynecol 128(4):761–770

    Article  PubMed  Google Scholar 

  23. Wright JD, Jorge S, Tergas AI et al (2016) Utilization and outcomes of ovarian conservation in premenopausal women with endometrial cancer. Obstet Gynecol 127(1):101–108

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  24. Park JY, Seong SJ, Kim TJ et al (2013) Pregnancy outcomes after fertility-sparing management in young women with early EC. Obstet Gynecol 121:136–142

    Article  PubMed  Google Scholar 

  25. Ichinose M, Fujimoto A, Osuga Y et al (2013) The influence of infertility treatment on the prognosis of EC and atypical complex endometrial hyperplasia. Int J Gynecol Cancer 23:288–293

    Article  PubMed  Google Scholar 

  26. Staff S, Aaltonen M, Huhtala H et al (2016) Endometrial cancer risk factors among Lynch syndrome women: a retrospective cohort study. Br J Cancer 115(3):375–381

    Article  PubMed  PubMed Central  Google Scholar 

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Funding

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

Author information

Authors and Affiliations

  1. Department of Gynecological Oncology, Norfolk and Norwich University Hospital, NHS Trust, Norwich, UK

    M. La Russa

  2. Gynecologic Oncology Unit, La Paz University Hospital, IdiPAZ, Madrid, Spain

    I. Zapardiel

  3. Department of Obstetrics and Gynaecology, 3rd Medical Faculty, Charles University Prague, Faculty Hospital Kralovske Vinohrady, Srobarova 1150/50, Praha 10, 100 34, Prague, Czech Republic

    M. J. Halaska

  4. Department of Gynecologic Oncology, Holycross Cancer Center, Kielce, Poland

    K. Zalewski

  5. Department of Obstetrics, Gynecology and Oncology, 2nd Faculty of Medicine, Warsaw Medical University, Warsaw, Poland

    K. Zalewski

  6. Department of Molecular and Translational Oncology, Maria Sklodowska-Curie Memorial Cancer Center, Institute of Oncology, Warsaw, Poland

    K. Zalewski

  7. Division of Gynecology, Medical University Graz, Graz, Austria

    R. Laky

  8. Department of Obstetrics and Gynecology, Baskent University School of Medicine, Ankara, Turkey

    P. Dursun

  9. Department of Radiation Sciences, Umeå University, Umeå, Sweden

    D. Lindquist

  10. Department of Oncogynecology, Grigoriev Institute for Medical Radiology, Kharkiv, Ukraine

    V. Sukhin

  11. Department of Gynecology and Gynecologic Oncology, Medical University of Vienna, Vienna, Austria

    S. Polterauer

  12. Department Gynecological Oncology, Poole NHS Trust, Poole, UK

    I. Biliatis

Authors
  1. M. La Russa
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  2. I. Zapardiel
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  3. M. J. Halaska
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  4. K. Zalewski
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  5. R. Laky
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  6. P. Dursun
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  7. D. Lindquist
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  8. V. Sukhin
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  9. S. Polterauer
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  10. I. Biliatis
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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

Corresponding author

Correspondence to M. J. Halaska.

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

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

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La Russa, M., Zapardiel, I., Halaska, M.J. et al. Conservative management of endometrial cancer: a survey amongst European clinicians. Arch Gynecol Obstet 298, 373–380 (2018). https://doi.org/10.1007/s00404-018-4820-7

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  • DOI: https://doi.org/10.1007/s00404-018-4820-7

Keywords

  • Endometrial cancer
  • Conservative management
  • Progestins
  • Assisted reproduction
  • Pregnancies