O-29: Fertility Sparing Treatments in Young Patients with Gynecological Cancers: A Large Iranian Experience and A Literature Review

Background: The marriage age has been increasing recently throughout the world and researches have shown an increased rate of gynecological cancers among young women. Therefore, fertility sparing in these patients is an important point and many works have been done on conservative management in young women with gynecological cancer. Materials and Methods: In this study, we report our experience in fertility sparing in cervical, endometrial and ovarian cancers and a literature review of the experiences in the world. Results: In case of cervical cancer, radical trachelectomy with para-aortic and pelvic lymphadenectomy can be done in patients with earlier stages such as stage IA1-IB. Since patients with early stages have had low recurrence rate, we can investigate them for radical vaginal or abdominal trachelectomy. Also there are more experiences about radical vaginal trachelectomy with laparoscopic pelvic and para-aortic lymphadenectomy. The complication of this surgery is lower than radical hysterectomy. Also the complications of pregnancy are abortion, preterm labor and preterm rupture of membrane (PROM). In endometrial cancer, the best treatment is total abdominal hysterectomy + bilateral salpango - oopherectomy (TAH+BSO), but young patients with early stage (stage I), are suggested to use hormonal therapy vs. radical surgery. If we evaluate the patients completely by MRI and the result is the early stage disease without the other site involvement while the grade of tumor is welldifferentiated, we can do hormonal therapy for these patients. GNRH analog, oral medroxyprogestrone acetate (MPA), 100-800 mg/day, megestrol acetate 40-160 mg/ day and combination of tamoxifen and a progestin are used for treatment. However, it is important to note that they should undergo a repeated curettage for investigating the medical treatment after 3 months of using drug. If they have normal pathology we will follow medical therapy for 3 months after curettage and they can be evaluated for infertility treatment. The best option for patients treated by medical therapy is TAH+BSO after termination of normal term pregnancy. In ovarian cancer, there are many experiences on fertility sparing surgery. The results of studies in Iran have shown that in order to preserve fertility, conservative surgical management could be performed in young patients with stage I (grade 1, 2) of epithelial ovarian tumor, sex cord-stromal tumor and patients with borderline and germ cell ovarian tumors. Conclusion: Fertility sparing in young women with gynecological cancer is a novel point which should consider before starting the surgical treatment and getting consent inform from the couples is so important.