Fertility-sparing management of low-grade XXXX : analysis of an institutional series and review of the literature.

@entity6019 @entity1 @entity6303 @entity5
OBJECTIVE: Low-grade @entity6019 (LG-ESS) is a rare @entity5 , often occurring before menopause. There is no consensus regarding its optimal management. Total hysterectomy and bilateral salpingo-oophorectomy precludes future fertility and may thus be undesirable by @entity1 wishing to maintain their reproductive potential. However, experience of fertility-sparing management in LG-ESS is very limited. In this paper, the disease outcome is presented in six young @entity1 with LG-ESS conservatively treated by combined hysteroscopic resection and hormonal therapy. STUDY DESIGN: From October 2009 to February 2013, at the Gynecologic Oncology Department of the National @entity5 Institute of Naples, six @entity1 , with early-stage LG-ESS aged 18-40 years who desired childbearing and/or retaining their fertility, were enrolled into a pilot study of fertility-sparing management. Diagnosis of LG-ESS was made on specimens from hysteroscopic resection performed on a presumed benign lesion. All @entity1 were planned to be treated with adjuvant @entity6303 for two years. Hormonal therapy was started within 6 weeks from the hysteroscopic resection, with orally @entity6303 at 40mg daily, increasing gradually according to @entity1 's tolerance to the recommended total dose of 160mg daily. RESULTS: All @entity1 were submitted to hysteroscopic resection in a one-step procedure. Five @entity1 started @entity6303 within 6 weeks from the hysteroscopic resection (one @entity1 did not start hormonal therapy because of early pregnancy after the hysteroscopic resection). Hormonal therapy was well tolerated; one @entity1 stopped @entity6303 after 12 months because of self-supporting strong desire to conceive; the other four @entity1 regularly completed the hormonal therapy. To date, all @entity1 show no evidence of disease. CONCLUSIONS: Although fertility-sparing management is not the current standard of care for young @entity1 with early-stage LG-ESS, our preliminary data are promising. Larger series with a longer follow-up are needed to further assess safety and efficacy of combined hysteroscopic resection and hormonal therapy.
