Conservative management of endometrial cancer: a survey amongst European clinicians
Language English Country Germany Media print-electronic
Document type Journal Article, Research Support, Non-U.S. Gov't
PubMed
29943129
DOI
10.1007/s00404-018-4820-7
PII: 10.1007/s00404-018-4820-7
Knihovny.cz E-resources
- Keywords
- Assisted reproduction, Conservative management, Endometrial cancer, Pregnancies, Progestins,
- MeSH
- Reproductive Techniques, Assisted MeSH
- Dilatation and Curettage MeSH
- Adult MeSH
- Endometrium pathology MeSH
- Antineoplastic Agents, Hormonal therapeutic use MeSH
- Hysteroscopy MeSH
- Conservative Treatment methods MeSH
- Humans MeSH
- Neoplasm Recurrence, Local pathology therapy MeSH
- Medroxyprogesterone Acetate therapeutic use MeSH
- Myometrium pathology MeSH
- Endometrial Neoplasms drug therapy pathology MeSH
- Progestins therapeutic use MeSH
- Retrospective Studies MeSH
- Pregnancy MeSH
- Treatment Outcome MeSH
- Fertility Preservation MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Pregnancy MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Geographicals
- Europe MeSH
- Names of Substances
- Antineoplastic Agents, Hormonal MeSH
- Medroxyprogesterone Acetate MeSH
- Progestins MeSH
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 Obstetrics and Gynecology Baskent University School of Medicine Ankara Turkey
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
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