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.

Department Gynecological Oncology Poole NHS Trust Poole UK

Department of Gynecologic Oncology Holycross Cancer Center Kielce Poland

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

Department of Gynecology and Gynecologic Oncology Medical University of Vienna Vienna Austria

Department of Molecular and Translational Oncology Maria Sklodowska Curie Memorial Cancer Center Institute of Oncology Warsaw Poland

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

Department of Obstetrics and Gynecology Baskent University School of Medicine Ankara Turkey

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

Department of Oncogynecology Grigoriev Institute for Medical Radiology Kharkiv Ukraine

Department of Radiation Sciences Umeå University Umeå Sweden

Division of Gynecology Medical University Graz Graz Austria

Gynecologic Oncology Unit La Paz University Hospital IdiPAZ Madrid Spain

Arch Gynecol Obstet. 2020 Nov;302(5):1305-1306. doi: 10.1007/s00404-018-5028-6. PubMed

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