Fertility-Sparing Treatment in Early-Stage Endometrial Cancer

Endometrial cancer (EC) in women of childbearing age is rare. It is estimated that only 4% of EC patients are younger than 40 years of age [1]. The median age at first delivery, however, is constantly rising in developed countries, due to the trend to postpone parenting for social reasons. Thus, the incidence of EC diagnosed before completion of the reproductive pathway is increasing [2]. Young women are usually diagnosed with low-grade, early-stage disease, and have excellent prognosis with 5- and 10-year disease-free survival (DFS) of up to 99.2 and 98%, respectively [3, 4]. The standard treatment (hysterectomy, bilateral salpingo-oophorectomy, and eventually pelvic and aortic lymphadenectomy) precludes future fertility and may thus be undesirable by women wishing to maintain their reproductive potential. Given the excellent oncologic outcomes associated with early-stage EC, the importance of improving quality of life and preserving fertility has been recognized. Fertility-sparing options for EC management have increasingly been investigated, but a contemporary consensus standardizing a conservative approach has not yet been defined.