Kim MK, et al. J Gynecol Oncol. 2018 Aug;30:e47. https://doi.org/10.3802/jgo.2019.30.e47

Endometrial cancer (EC) in young women tends to be early-stage and low-grade; therefore, such cases have good prognoses. Fertility-sparing treatment with progestin is a potential alternative to definitive treatment (i.e., total hysterectomy, bilateral salpingo-oophorectomy, pelvic washing, and/or lymphadenectomy) for selected patients. However, no evidence-based consensus or guidelines yet exist, and this topic is subject to much debate. Generally, the ideal candidates for fertility-sparing treatment have been suggested to be young women with grade 1 endometrioid adenocarcinoma confined to the endometrium. Magnetic resonance imaging should be performed to rule out myometrial invasion and extrauterine disease before initiating fertility-sparing treatment. Although various fertility-sparing treatment methods exist, including the levonorgestrel-intrauterine system, metformin, gonadotropin-releasing hormone agonists, photodynamic therapy, and hysteroscopic resection, the most common method is high-dose oral progestin (medroxyprogesterone acetate at 500–600 mg daily or megestrol acetate at 160 mg daily). During treatment, re-evaluation of the endometrium with dilation and curettage at 3 months is recommended. Although no consensus exists regarding the ideal duration of maintenance treatment after achieving regression, it is reasonable to consider maintaining the progestin therapy until pregnancy with individualization. According to the literature, the ovarian stimulation drugs used for fertility treatments appear safe. Hysterectomy should be performed after childbearing, and hysterectomy without oophorectomy can also be considered for young women. The available evidence suggests that fertility-sparing treatment is effective and does not appear to worsen the prognosis. If an eligible patient strongly desires fertility despite the risk of recurrence, the clinician should consider fertility-sparing treatment with close follow-up.

Choi SH, et al. Yonsei Med J. 2023 Mar;64(3):204-212. https://doi.org/10.3349/ymj.2022.0278

Kim SJ, et al. Yonsei Med J. 2022 May;63(5):446-451. https://doi.org/10.3349/ymj.2022.63.5.446

Kim MK, et al. J Gynecol Oncol. 2019 Jun;31:e51. https://doi.org/10.3802/jgo.2020.31.e51

Kim DH, et al. J Gynecol Oncol. 2016 Aug;28:e1. http://dx.doi.org/10.3802/jgo.2017.28.e1