As survival rates for gynecological malignancies are increasing as a result of improved prevention and screening strategies, there is a growing focus on improving long-term quality of life. The treatment of gynecological malignancies typically involves surgery, chemotherapy and/or radiotherapy, and often results in permanent infertility. Whilst the effective treatment of the cancer should not be compromised, for patients who are still of reproductive age, it is important to preserve fertility where possible, in order to improve long-term quality-of-life. For a select group of patients with early stage gynecological malignancies, advances in the use of fertility-preserving treatments (FPTs) which allow the ovaries, uterus and cervix to be at least partially preserved, may enable fertility to be maintained.
Around 20% of cervical cancer cases are diagnosed in adolescent and young adult (AYA) patients (patients under 40). The standard treatment approach for early stage cervical cancer is radical hysterectomy, sometimes followed by pelvic lymphadenectomy or sentinel lymph node detection. FPT options include conization and simple or radical trachelectomy and have demonstrated acceptable oncological outcomes, similar to those with radical hysterectomy. However, pregnancy rates following abdominal radical trachelectomy remain low.
Although invasive epithelial ovarian cancer primarily affects post-menopausal women, a small proportion of women of reproductive age are diagnosed. In FPT approaches, the contralateral ovary and uterus are not removed; however, this approach remains debated due to a lack of data comparing FPT and non-FPT approaches and the use of this approach in women with high-risk prognostic factors.
Roughly 4% of endometrial cancer cases are diagnosed in AYA patients. Standard treatment involves full hysterectomy and bilateral salpingo-oophorectomy, achieving a 93% cure rate. The FPT approach involves hysteroscopic resection and/or curettage and progestin therapy, reporting complete remission rates between 50% and 75%. For patients who experience recurrence after achieving complete remission and still wish to preserve fertility, fertility-preserving re-treatment has been demonstrated to achieve a promising response. Furthermore, insulin resistance, metabolic syndrome, and obesity are being explored as predictors of outcomes to guide patient selection.
Whilst FPTs are available for the treatment of gynecologic malignancies, more research into patient selection, long-term oncological and fertility outcomes, and optimal follow-up strategies is required. Additionally, the role of maintenance therapy after FPT needs further exploration, as well as the identification of predictive factors for response to FPT in order to improve patient selection. Furthermore, the growing availability of more targeted, personalized therapies may provide novel FPT options in the future.
This collection invites Original Research, Clinical Trial, Review and Mini-Review papers contributing to optimizing patient selection, identifying predictive factors for response, and improving oncological and fertility outcomes in patients with gynecologic malignancies receiving FPT.
Please note: manuscripts consisting solely of bioinformatics or computational analysis of public genomic or transcriptomic databases which are not accompanied by validation (independent cohort or biological validation in vitro or in vivo) are out of scope for this section and will not be accepted as part of this Research Topic.
As survival rates for gynecological malignancies are increasing as a result of improved prevention and screening strategies, there is a growing focus on improving long-term quality of life. The treatment of gynecological malignancies typically involves surgery, chemotherapy and/or radiotherapy, and often results in permanent infertility. Whilst the effective treatment of the cancer should not be compromised, for patients who are still of reproductive age, it is important to preserve fertility where possible, in order to improve long-term quality-of-life. For a select group of patients with early stage gynecological malignancies, advances in the use of fertility-preserving treatments (FPTs) which allow the ovaries, uterus and cervix to be at least partially preserved, may enable fertility to be maintained.
Around 20% of cervical cancer cases are diagnosed in adolescent and young adult (AYA) patients (patients under 40). The standard treatment approach for early stage cervical cancer is radical hysterectomy, sometimes followed by pelvic lymphadenectomy or sentinel lymph node detection. FPT options include conization and simple or radical trachelectomy and have demonstrated acceptable oncological outcomes, similar to those with radical hysterectomy. However, pregnancy rates following abdominal radical trachelectomy remain low.
Although invasive epithelial ovarian cancer primarily affects post-menopausal women, a small proportion of women of reproductive age are diagnosed. In FPT approaches, the contralateral ovary and uterus are not removed; however, this approach remains debated due to a lack of data comparing FPT and non-FPT approaches and the use of this approach in women with high-risk prognostic factors.
Roughly 4% of endometrial cancer cases are diagnosed in AYA patients. Standard treatment involves full hysterectomy and bilateral salpingo-oophorectomy, achieving a 93% cure rate. The FPT approach involves hysteroscopic resection and/or curettage and progestin therapy, reporting complete remission rates between 50% and 75%. For patients who experience recurrence after achieving complete remission and still wish to preserve fertility, fertility-preserving re-treatment has been demonstrated to achieve a promising response. Furthermore, insulin resistance, metabolic syndrome, and obesity are being explored as predictors of outcomes to guide patient selection.
Whilst FPTs are available for the treatment of gynecologic malignancies, more research into patient selection, long-term oncological and fertility outcomes, and optimal follow-up strategies is required. Additionally, the role of maintenance therapy after FPT needs further exploration, as well as the identification of predictive factors for response to FPT in order to improve patient selection. Furthermore, the growing availability of more targeted, personalized therapies may provide novel FPT options in the future.
This collection invites Original Research, Clinical Trial, Review and Mini-Review papers contributing to optimizing patient selection, identifying predictive factors for response, and improving oncological and fertility outcomes in patients with gynecologic malignancies receiving FPT.
Please note: manuscripts consisting solely of bioinformatics or computational analysis of public genomic or transcriptomic databases which are not accompanied by validation (independent cohort or biological validation in vitro or in vivo) are out of scope for this section and will not be accepted as part of this Research Topic.
