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This review article evaluates current fertility preservation strategies for young women diagnosed with gynecological cancers, specifically ovarian, endometrial, and cervical malignancies. The authors outline that eligibility varies by cancer type, noting that ovarian tissue cryopreservation is suitable for early-stage epithelial ovarian cancer, while hormonal therapy with progestins may preserve the uterus in selected cases of well-differentiated endometrial cancer. For cervical cancer, conservative surgical approaches like cone biopsy are presented as options for early-stage disease, with reported live birth rates ranging from approximately 47% to over 60% depending on the intervention. Relevance to endometriosis: listed as one indication for GnRH antagonists, though the paper's main focus is uterine fibroids.
Abstract
The aim of this review article is to present current options for fertility preservation in young women with gynecological tumors (ovarian, endometrial or cervical cancer). An early pretreatment referral to multidisciplinary team which consists of general gynecologists, gynecologic oncologists, embryologists, radiologists, pathologists, and reproductive endocrinologists should be suggested to young women with gynecologic cancer, concerning the risks and benefits of fertility preservation options. Only a small percentage of patients with ovarian cancer and borderline ovarian tumors, are appropriate candidates for fertility preservation (FIGO stage IA and IC epithelial ovarian cancer). Following oophorectomy, ovarian tissue or oocytes are removed from the ovary for the use of cryopreservation; after completion of oncological treatment patient undergoes orthotopic retransplantation of ovarian tissue whereas oocytes may be used for in vitro fertilization. Live birth rates up to 53.8% have been reported after fertility preservation treatment in selected patients. In patients with endometrial cancer fertility preservation treatment means conserving of the uterus. Appropriate candidates for fertility preservation are younger women with well differentiated endometrial cancer, which does not invade the myometrium. Fertility preservation treatment in endometrial cancer is hormonal, based on progestins. After completion of fertility preservation treatment, frequent follow-ups are necessary, with tissue sampling (via curettage or endometrial biopsy) remaining standard approach in follow- up. Live birth rates after progestin therapy are around 60%, or even higher with the help of assisted reproductive procedures. In cervical cancer, fertility preservation treatment can be considered in women with early-stage disease (FIGO IA1, IA2, or IB1). Cone biopsy or conization followed by laparoscopic lymphadenectomy has been described as an appropriate procedure, with conception rates up to 47%.
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Pregledni rad
https://doi.org/10.20471/LO.2022.50.02-03.20
Fertility preservation in patients with gynecological cancer - is it possible?
Zrinka Rendić-Miočević
; Division of Oncology and Radiotherapy, University Hospital for Tumors, Sestre milosrdnice University Hospital Center, Zagreb, Croatia
Mirna Alvir
; Emergency Department, Universitiy Hospital Center Zagreb, Zagreb, Croatia
Ivana Orešković
; School of Medicine, University of Zagreb, Zagreb, Croatia
Lidija Beketić-Orešković
; Division of Oncology and Radiotherapy, University Hospital for Tumors, Sestre milosrdnice University Hospital Center, Zagreb, Croatia; Department of Clinical Oncology, School of Medicine, University of Zagreb, Zagreb, Croatia
Sažetak
The aim of this review article is to present current options for fertility preservation in young women with gynecological tumors (ovarian, endometrial or cervical cancer). An early pretreatment referral to multidisciplinary team which consists of general gynecologists, gynecologic oncologists, embryologists, radiologists, pathologists, and reproductive endocrinologists should be suggested to young women with gynecologic cancer, concerning the risks and benefits of fertility preservation options. Only a small percentage of patients with ovarian cancer and borderline ovarian tumors, are appropriate candidates for fertility preservation (FIGO stage IA and IC epithelial ovarian cancer). Following oophorectomy, ovarian tissue or oocytes are removed from the ovary for the use of cryopreservation; after completion of oncological treatment patient undergoes orthotopic retransplantation of ovarian tissue whereas oocytes may be used for in vitro fertilization. Live birth rates up to 53.8% have been reported after fertility preservation treatment in selected patients. In patients with endometrial cancer fertility preservation treatment means conserving of the uterus. Appropriate candidates for fertility preservation are younger women with well differentiated endometrial cancer, which does not invade the myometrium. Fertility preservation treatment in endometrial cancer is hormonal, based on progestins. After completion of fertility preservation treatment, frequent follow-ups are necessary, with tissue sampling (via curettage or endometrial biopsy) remaining standard approach in follow- up. Live birth rates after progestin therapy are around 60%, or even higher with the help of assisted reproductive procedures. In cervical cancer, fertility preservation treatment can be considered in women with early-stage disease (FIGO IA1, IA2, or IB1). Cone biopsy or conization followed by laparoscopic lymphadenectomy has been described as an appropriate procedure, with conception rates up to 47%.
Ključne riječi
fertility preservation – gynecological oncology; ovarian cancer; endometrial cancer; cervical cancer
Hrčak ID:
288547
URI
Datum izdavanja:
22.12.2022.
Posjeta: 2.294 *
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