Fertility-Preserving Treatments in Patients with Gynecological Cancers: Chinese Experience and Literature Review


We conducted a retrospectively reviewed of the literature published of patients underwent fertility-preservingtreatments for cervical, endometrial and ovarian cancers using the WANFANG database in Chinese. A majoritywere retrospective studies and case reports. With cervical cancer, radical trachelectomy(RT) in combinationwith pelvic lymphadenectomy could preserve the fertility of patients with early stage IA1-IB1 cancers, Tumorsize ≤2cm should be emphasized as the indication of RT in considering of the higher recurrent rate in patientswith tumor size >2cm. For endometrial cancers, there is much experience on it. Given accurate pretreatmentassessment, hormonal therapy is feasible management option to preserve fertility in young patients with earlystage lesions that limited to the endometrium and well differentiated. High dose progestin have been applied,oral medroxyprogesterone acetate (MPA), 250-500mg/day, megestrol acetate 160-480mg/day. Other therapiesthat have been used in a limited number of cases include GnRH analog, intrauterine devices (IUDS) containingprogestogen, usually combination of these therapies. All patients should be followed up by ultrasound and/orMRI evaluation, and endometrial curettage at intervals of 3 months. With ovarian cancer, in China, fertilitypreservingsurgery in patients with stage IA (grade G1) of epithelial ovarian tumor and patients with germ celltumor and borderline ovarian tumor have been successfully performed.