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International Journal of Clinical Oncology

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01-06-2019 | Fertility | Original Article

Prolonged conservative treatment in patients with recurrent endometrial cancer after primary fertility-sparing therapy: 15-year experience

Authors: Yao Wang, Mei Yu, Jia-xin Yang, Dong-yan Cao, Zhen Yuan, Hui-mei Zhou, Ying Zhang, Lei Li, Keng Shen, Huanwen Wu

Published in: International Journal of Clinical Oncology | Issue 6/2019

Abstract

Objective

To evaluate the efficacy and prognosis of repeated treatment on patients with recurrent endometrial cancer (EC) after complete remission for primary fertility-preserving therapy.

Materials and methods

We performed a retrospective study of patients with presumed stage IA endometrial cancer who had recurrence after achieving complete remission by fertility-preserving management at the Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, from January 2003 to April 2018. For each patient, medical records and pathology reports were reviewed. The demographic features, treatment efficacy, tumor prognosis, and reproductive outcome were analyzed.

Results

Of the 41 recurrent patients with a median disease-free interval period of 16 months (range, 5–55 months), 23 were diagnosed at recurrence as EC, and 18 were diagnosed as atypical hyperplasia (AH) or endometrial intraepithelial neoplasia (EIN). 26 patients received repeated fertility-preserving treatment, and 23 patients were evaluable for efficacy. The complete response (CR) rate of repeated treatment (19/23, 82.6%) was lower than that of primary fertility-preserving treatment (161/170, 94.7%) with borderline significance (P = 0.053). The CR rate of AH/EIN patients was higher than that of EC patients with no statistical difference (92.9% vs 66.7%, P = 0.260). Among 19 patients achieved CR, 3 got pregnant and delivered successfully, while 3 had a second relapse. Four cases failed to response to the repeated treatment and underwent definitive surgery. 15 patients referred to definitive surgery directly after recurrence and one of them had a pelvic recurrence after 120 months. All patients are alive without evidence of disease at last follow-up.

Conclusions

For patients with recurrent EC after primary fertility-preserving treatment, repeated fertility-preserving treatment can still achieve a promising response and patients have possibilities of completing childbirth.

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Title: Prolonged conservative treatment in patients with recurrent endometrial cancer after primary fertility-sparing therapy: 15-year experience
Authors: Yao Wang
Mei Yu
Jia-xin Yang
Dong-yan Cao
Zhen Yuan
Hui-mei Zhou
Ying Zhang
Lei Li
Keng Shen
Huanwen Wu
Publication date: 01-06-2019
Publisher: Springer Singapore
Keywords: Fertility
Endometrial Cancer
Endometrial Cancer
Progestin
Published in: International Journal of Clinical Oncology / Issue 6/2019
Print ISSN: 1341-9625
Electronic ISSN: 1437-7772
DOI: https://doi.org/10.1007/s10147-019-01404-2

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