f8639df25bcf86990d6ed7edd88529c5 320382.pdf 68b7d713850bbf44ebef58f09388bf3a40b42cfa 320382.pdf f1b32ff85cd22034865b9c25328e18976bc69bcbdad6002ea5a70757beb4b2f7 320382.pdf Title: Fertility Sparing in Endometrial Cancer: Where Are We Now? Subject: Endometrial cancer is the most common gynecological neoplasm with an increased incidence in the premenopausal population in recent decades. This raises the problem of managing endometrial cancer in fertile women who have not yet achieved pregnancy. In these women, after careful selection, hysterectomy may be postponed in favor of conservative management if specific requirements are met. The latest evidence is focused on early endometrial carcinoma, endometrioid histotype, Grading 1, with no evidence of myometrial infiltration. Few clinical trials have opened this possibility also for women with an endometrial cancer Grading 2 diagnosis. There are still questions about the best medical therapy, dosage, route, and duration of treatment. Oral progestins or levonorgestrel-releasing intrauterine devices appear to be the options associated with the best outcome in terms of complete response and lower recurrence rates. Other options include the use of GnRH analogues, surgical hysteroscopy, or metformin, in a therapeutic approach that takes into account the characteristics of the patient. The pursuit of pregnancy should start as soon as two consecutive endometrial biopsies are obtained 3 months apart from each other; it is recommended to refer the patients to ART centers to maximize the success rate. After having reached the fulfillment of the reproductive desire, surgical radical treatment is still recommended. Keywords: endometrial cancer; fertility sparing; uterine neoplasms Author: Gabriele Centini, Irene Colombi, Ilaria Ianes, Federica Perelli, Alessandro Ginetti, Alberto Cannoni, Nassir Habib, Ramon Rovira Negre, Francesco Giuseppe Martire, Diego Raimondo, Lucia Lazzeri and Errico Zupi Creator: LaTeX with hyperref Producer: pdfTeX-1.40.25 CreationDate: Wed Jan 1 10:03:58 2025 CET ModDate: Wed Jan 1 10:25:38 2025 CET Custom Metadata: no Metadata Stream: no Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 17 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 1413525 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- ATKGTC+URWPalladioL-Roma Type 1 Custom yes yes yes 10 0 TRWFLV+URWPalladioL-Bold Type 1 Custom yes yes yes 16 0 IXMUNC+URWPalladioL-Ital Type 1 Custom yes yes yes 21 0 PXTEMV+CMSY10 Type 1 Builtin yes yes yes 59 0 PKKOHP+TimesNewRoman CID TrueType Identity-H yes yes yes 71 0 PKKOKA+PalatinoLinotype TrueType WinAnsi yes yes no 77 0 CDKKOM+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 97 0 CDKKOO+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 100 0 CDKKPO+PalatinoLinotype CID TrueType Identity-H yes yes yes 103 0 CDKKPP+PalatinoLinotype TrueType WinAnsi yes yes no 109 0 CDKLAA+PalatinoLinotype TrueType MacRoman yes yes no 112 0 CDKKOM+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 126 0 CDKKOO+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 129 0 CDKKPP+PalatinoLinotype TrueType WinAnsi yes yes no 132 0 CDKLAA+PalatinoLinotype TrueType MacRoman yes yes no 135 0 CDKKOM+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 147 0 CDKKOO+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 150 0 CDKKPO+PalatinoLinotype CID TrueType Identity-H yes yes yes 153 0 CDKKPP+PalatinoLinotype TrueType WinAnsi yes yes no 159 0 CDKLAA+PalatinoLinotype TrueType MacRoman yes yes no 162 0 QMBQCI+VnURWPalladioL Type 1 Custom yes yes yes 182 0 Jhove (Rel. 1.28.0, 2023-05-18) Date: 2025-10-08 03:52:06 CEST RepresentationInformation: 320382.pdf ReportingModule: PDF-hul, Rel. 1.12.4 (2023-03-16) LastModified: 2025-10-07 13:57:28 CEST Size: 1413525 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 437 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Background Destination: section.1 Item: Title: Materials and Methods Destination: section.2 Item: Title: Results Destination: section.3 Children: Item: Title: Eligibility for Fertility-Sparing Treatment Destination: subsection.3.1 Item: Title: Treatment Strategies Destination: subsection.3.2 Children: Item: Title: Progestins Destination: subsubsection.3.2.1 Item: Title: Other Strategies Destination: subsubsection.3.2.2 Item: Title: Duration of Treatment Destination: subsubsection.3.2.3 Item: Title: Follow Up and Pre-Conception Counselling Destination: subsection.3.3 Item: Title: The Role of Molecular Patterns in Fertility-Sparing Treatment Destination: subsection.3.4 Item: Title: Conclusions Destination: section.4 Item: Title: References Destination: section.5 Info: Title: Fertility Sparing in Endometrial Cancer: Where Are We Now? Author: Gabriele Centini, Irene Colombi, Ilaria Ianes, Federica Perelli, Alessandro Ginetti, Alberto Cannoni, Nassir Habib, Ramon Rovira Negre, Francesco Giuseppe Martire, Diego Raimondo, Lucia Lazzeri and Errico Zupi Subject: Endometrial cancer is the most common gynecological neoplasm with an increased incidence in the premenopausal population in recent decades. This raises the problem of managing endometrial cancer in fertile women who have not yet achieved pregnancy. In these women, after careful selection, hysterectomy may be postponed in favor of conservative management if specific requirements are met. The latest evidence is focused on early endometrial carcinoma, endometrioid histotype, Grading 1, with no evidence of myometrial infiltration. Few clinical trials have opened this possibility also for women with an endometrial cancer Grading 2 diagnosis. There are still questions about the best medical therapy, dosage, route, and duration of treatment. Oral progestins or levonorgestrel-releasing intrauterine devices appear to be the options associated with the best outcome in terms of complete response and lower recurrence rates. Other options include the use of GnRH analogues, surgical hysteroscopy, or metformin, in a therapeutic approach that takes into account the characteristics of the patient. The pursuit of pregnancy should start as soon as two consecutive endometrial biopsies are obtained 3 months apart from each other; it is recommended to refer the patients to ART centers to maximize the success rate. After having reached the fulfillment of the reproductive desire, surgical radical treatment is still recommended. 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