Kelly Gynecologic Oncology Service (Drs. Kohn, Kashi, Acosta-Torres, and Beavis).
Kelly Gynecologic Oncology Service (Drs. Kohn, Kashi, Acosta-Torres, and Beavis).
J Minim Invasive Gynecol. 2021 Mar;28(3):392-402. doi: 10.1016/j.jmig.2020.12.027. Epub 2020 Dec 26.
Nearly 10% of the 1.3 million women living with a gynecologic cancer are aged <50 years. For these women, although their cancer treatment can be lifesaving, it's also life-altering because traditional surgical procedures can cause infertility and, in many cases, induce surgical menopause. For appropriately selected patients, fertility-sparing options can reduce the reproductive impact of lifesaving cancer treatments. This review will highlight existing recommendations as well as innovative research for fertility-sparing treatment in the 3 major gynecologic cancers.
TABULATION, INTEGRATION, AND RESULTS: For early-stage cervical cancers, fertility-sparing surgeries include cold knife conization, simple hysterectomy with ovarian preservation, or radical trachelectomy with placement of a permanent cerclage. In locally advanced cervical cancer, ovarian transposition before radiation therapy can help preserve ovarian function. For endometrial cancers, fertility-sparing treatment includes progestin therapy with endometrial sampling every 3 to 6 months. After cancer regression, progestin therapy can be halted to allow attempts to conceive. Hysterectomy with ovarian preservation can also be considered, allowing for fertility using assisted reproductive technology and a gestational carrier. For ovarian cancers, fertility-sparing surgery includes unilateral salpingo-oophorectomy or bilateral salpingo-oophorectomy (with lymphadenectomy and staging depending on tumor histology). With higher-risk histology or higher early-stage disease, adjuvant chemotherapy is recommended-however, this carries a 3% to 10% risk of ovarian failure. Use of oocyte or embryo cryopreservation in patients with early-stage ovarian malignancy remains an area of ongoing research.
Overall, fertility-sparing management of gynecologic cancers is associated with acceptable rates of progression-free survival and overall survival and is less life-altering than more radical surgical approaches.
在 130 万患有妇科癌症的女性中，近 10%的年龄<50 岁。对于这些女性来说，尽管癌症治疗可以挽救生命，但也会改变生活，因为传统的手术程序可能导致不孕，并且在许多情况下会导致手术性绝经。对于适当选择的患者，保留生育力的选择可以降低挽救生命的癌症治疗对生殖的影响。本综述将重点介绍在 3 种主要妇科癌症中保留生育力治疗的现有建议和创新研究。
列表、整合和结果：对于早期宫颈癌，保留生育力的手术包括冷刀锥切术、简单子宫切除术加卵巢保留术，或根治性子宫颈切除术加永久性环扎术。在局部晚期宫颈癌中，放射治疗前的卵巢移位术有助于保留卵巢功能。对于子宫内膜癌，保留生育力的治疗包括孕激素治疗，每 3 至 6 个月进行子宫内膜取样。癌症消退后，可以停止孕激素治疗，以尝试怀孕。保留卵巢的子宫切除术也可以考虑，通过辅助生殖技术和代孕者来实现生育。对于卵巢癌，保留生育力的手术包括单侧输卵管卵巢切除术或双侧输卵管卵巢切除术（根据肿瘤组织学进行淋巴结切除术和分期）。对于高风险组织学或早期疾病较高的患者，建议辅助化疗-然而，这会带来 3%至 10%的卵巢衰竭风险。在早期卵巢恶性肿瘤患者中使用卵母细胞或胚胎冷冻保存仍然是一个正在进行研究的领域。
总的来说，妇科癌症的保留生育力管理与可接受的无进展生存率和总生存率相关，并且比更激进的手术方法对生活的改变更小。
