Update on fertility-sparing treatment in primary and recurrent endometrial cancer

Endometrial cancer is one of the most frequent female cancers in women. Around 3-14% of endometrial cancers are diagnosed in young women wishing to preserve their fertility. Incidence of endometrial cancer in this age group is increasing, for which fertility-sparing therapy is increasingly need to be used to preserve quality of life in these patients. Progestin-based treatment is the most common type of fertility-sparing therapy. The aim of this review is to assess and analyse most recent findings concerning fertility-sparing progestin therapy for young women with primary and recurrent endometrial cancer. Diagnosis, treatment, follow-up, and oncologic and reproductive outcomes are investigated. Fertility-sparing progestin therapy is highly effective in selected young women with primary and recurrent endometrial cancer. Patients careful selection as to be mandatory to achieve the best outcomes without compromising survival. Because of the not negligible recurrence rate after conservative treatment, close surveillance is required and prophylactic hysterectomy has to be performed in patients completing family planning. Pregnancy outcomes are very encouraging, thanks to assisted reproductive technologies. Medroxyprogesterone acetate and megestrol acetate are the ideal progestins employed for fertility-sparing therapy, but further studies should be made to establish the optimal dose and treatment timing in this setting.