Fertility-Sparing Treatments in Endometrial Cancer: A Comprehensive Review on Efficacy, Oncological Outcomes, and Reproductive Potential.

IF 2.4 4区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Carlo Ronsini, Paola Romeo, Giada Andreoli, Vittorio Palmara, Marco Palumbo, Giuseppe Caruso, Pasquale De Franciscis, Giuseppe Vizzielli, Stefano Restaino, Vito Chiantera, Stefano Cianci
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Abstract

Endometrial cancer (EC) affects 3-14% of women under 40 who wish to preserve their fertility. The standard treatment for EC is a hysterectomy with salpingo-oophorectomy. However, for those desiring fertility preservation, oral progestogens such as medroxy-progesterone acetate (MPA) or megestrol acetate (MA) are the most common therapies in Fertility-Sparing Treatment (FST). Other treatments include gonadotropin-releasing hormone agonist (GnRHa), levonorgestrel-releasing intrauterine system (LNG-IUS), and metformin plus progestin. This comprehensive review evaluates the best FST options for women with reproductive potential. PubMed, EMBASE, and Scopus were searched in June 2023 using specific keywords. Studies included in the review focused on patients with EC undergoing FST, with outcomes such as complete response rate (CRR), recurrence rate (RR), pregnancy rate (PR), and live birth rate. Eighteen studies met the inclusion criteria, involving 23,976 patients. In only-oral progestin trials, CRR ranged from 18% to 100%; RR ranged from 0% to 81.8%; Death Rate ranged from 0% to 3.6%. In studies combining oral progestin with LNG-IUS, CRR ranged from 55% to 87.5%; RR ranged from 0% to 41.7%; Death Rate was 0%. Most patients with Stage IA EC received MPA or MA. Fertility-related outcomes were reported in 15 studies. PR ranged from 4 to 44 patients in trials involving only oral progestins. When combining oral progestin with LNG-IUS, PR ranged from 1 to 46 patients. Progestin therapy, including oral MPA and MA, is considered safe and effective, with limited evidence supporting the use of LNG-IUS.

子宫内膜癌保留生育能力的治疗:疗效、肿瘤预后和生殖潜力的综合综述。
子宫内膜癌(EC)影响了3-14%希望保持生育能力的40岁以下妇女。EC的标准治疗是子宫切除术和输卵管卵巢切除术。然而,对于那些希望保留生育能力的人来说,口服孕激素如醋酸羟孕酮(MPA)或醋酸甲孕酮(MA)是保留生育能力治疗(FST)中最常见的治疗方法。其他治疗包括促性腺激素释放激素激动剂(GnRHa)、左炔诺孕酮释放宫内系统(LNG-IUS)和二甲双胍加黄体酮。这篇综合综述评估了有生育潜力的女性的最佳FST选择。在2023年6月使用特定关键词检索PubMed、EMBASE和Scopus。本综述纳入的研究主要集中在接受FST治疗的EC患者,研究结果包括完全缓解率(CRR)、复发率(RR)、妊娠率(PR)和活产率。18项研究符合纳入标准,涉及23,976例患者。在单口服黄体酮试验中,CRR范围从18%到100%;RR范围为0% ~ 81.8%;死亡率从0%到3.6%不等。在联合口服黄体酮与LNG-IUS的研究中,CRR范围为55%至87.5%;RR范围为0% ~ 41.7%;死亡率为0%。大多数IA期EC患者接受了MPA或MA治疗。15项研究报告了与生育有关的结果。在仅使用口服黄体酮的试验中,PR范围从4到44例。口服黄体酮联合LNG-IUS时,PR为1 ~ 46例。黄体酮治疗,包括口服MPA和MA,被认为是安全有效的,支持使用LNG-IUS的证据有限。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Medicina-Lithuania
Medicina-Lithuania 医学-医学:内科
CiteScore
3.30
自引率
3.80%
发文量
1578
审稿时长
25.04 days
期刊介绍: The journal’s main focus is on reviews as well as clinical and experimental investigations. The journal aims to advance knowledge related to problems in medicine in developing countries as well as developed economies, to disseminate research on global health, and to promote and foster prevention and treatment of diseases worldwide. MEDICINA publications cater to clinicians, diagnosticians and researchers, and serve as a forum to discuss the current status of health-related matters and their impact on a global and local scale.
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