Conservative therapeutic approach in young patients with endometrial cancer: is it really possible?

Fertility preservation in young patients with early stage endometrial cancer, represents a great therapeutic challenge nowadays. The eligible patients should have strong desire for future fertility, informed consent about conservative approach and no contraindications regarding medical treatment with progestins. Moreover, they should have an extensive counselling regarding disease recurrence, fertility and childbearing issues. Before starting conservative treatment, a thorough evaluation should be performed in every patient with both endometrial sampling and detailed visualization of the entire abdomen. Then, the carefully selected young patients, could initiate fertility sparing treatment which is mainly based on progestin regimens and should be taken for a period of 6 months. All patients should have a very close surveillance during and after conservative management. The overall response rate after fertility sparing treatment in endometrial cancer, is quite encouraging reaching approximately 75%. However, the overall recurrence rate in these patient subgroup, is essentially high ranging between 30% and 40%. This is the main reason why systematic surgical staging should be performed in all these patients after completion of childbearing. In conclusion, fertility sparing treatment is really possible only in young patients with FIGO stage IA, grade 1 and type I endometrial cancer. However, conservative management in endometrial cancer is not the standard of care and patients should be informed about the future need of systematic surgical staging in any treatment failure, disease recurrence or after completion of childbearing