No Surgery for Low-Grade Endometrial Cancer in Women with a Desire to Preserve Fertility

Objective: The treatment of endometrial cancer is total hysterectomy including bilateral salpingo-oophorectomy. Standard treatment takes away the possibility for fertile women to conceive. This review studies the effectiveness and safety of conservative/hormonal therapy for stage I grade 1 and 2 endometrial cancer. Materials and Methods: We searched Pubmed for publications from January 1968 to November 2008. Publications included retrospective studies, case reports, multicenter Phase II study, and literature reviews describing conservative treatment for women with type I endometrial cancer. Results: Fifty-five studies described 245 patients with stage I endometrial cancer. The median age of the patients was 30.3 years. Two hundred and thirty-two patients had grade 1 disease, and 16 had grade 2 or more. Grading was unknown for five patients. Patients were treated with different progestatives. Three out of 245 patients did not receive any treatment for their disease. The mean number of months of treatment was 7 months. One hundred and ninety-three of the 245 patients responded initially to therapy. Progesterone receptor status was known in 86 of 245 patients. Seventy-seven patients (90%) were progesterone receptor positive. The mean follow-up was 47 months. No patient died of endometrial cancer. One hundred and twenty-seven pregnancies and 109 living births were described. Conclusions: Conservative treatment of endometrial cancer may be considered in a well-selected group of patients: stage I, grade 1 and 2 endometrial cancer in women who want to preserve their fertility. The patients have to be treated according to a well-defined, preset protocol. The process should be well documented to improve the safety and effectiveness of the conservative treatment. (J GYNECOL SURG 28:389)