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Systematic Review

Uterine Preservation Treatments in Sarcomas: Oncological Problems and Reproductive Results: A Systematic Review

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Division of Oncologic Gynecology, IRCCS Azienda Ospedaliero—Universitaria di Bologna, 40138 Bologna, Italy
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Centro di Studio e Ricerca delle Neoplasie Ginecologiche (CSR), University of Bologna, 40138 Bologna, Italy
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Infertility and IVF Unit, IRCCS Azienda Ospedaliero—Universitaria di Bologna, 40138 Bologna, Italy
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Forensic Medicine and Integrated Risk Management Unit, Azienda Ospedaliero—Universitaria di Bologna, via Albertoni 15 alessandra 40138 Bologna, Italy
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Department of Pharmacy and Biotechnology, University of Bologna, 40138 Bologna, Italy
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Department of Experimental, Diagnostic and Specialty Medicine—DIMES, Alma Mater Studiorum—University of Bologna, 40138 Bologna, Italy
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Molecular Pathology Laboratory, IRCCS Azienda Ospedaliero—Universitaria di Bologna/Azienda USL di Bologna, 40138 Bologna, Italy
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Division of Oncology, IRCCS Azienda Ospedaliero—Universitaria di Bologna, 40138 Bologna, Italy
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Radiation Oncology, IRCCS Azienda Ospedaliero—Universitaria di Bologna, 40138 Bologna, Italy
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Author to whom correspondence should be addressed.
Academic Editor: David Wong
Cancers 2021, 13(22), 5808; https://doi.org/10.3390/cancers13225808
Received: 27 October 2021 / Revised: 9 November 2021 / Accepted: 17 November 2021 / Published: 19 November 2021
(This article belongs to the Special Issue Endometrial Cancer: Old Questions and New Perspectives)
Uterine sarcomas can affect patients of reproductive age. In this setting, the chance of a fertility-sparing treatment would allow women to become pregnant. In the literature, only a few experiences of fertility-sparing treatment of uterine sarcomas have been reported; however, the oncological safety and reproductive outcomes remain unclear. The aim of this systematic review is to report and summarize all the published evidence about the fertility-sparing approach in these rare and heterogenous tumors, and to help physicians in making clinical decisions.
Uterine sarcomas are rare cancers, sometimes diagnosed in women of childbearing age. Hysterectomy is the standard treatment in early stages. The option of lesion removal to save fertility is described in the literature, but it is still considered experimental. The objective of this systematic review is to report on the available evidence on the reproductive and oncological outcomes of fertility-sparing treatment in women with uterine sarcomas. PubMed, Scopus and Cochrane Central Register of Controlled Trials were searched between 1 January 2011 and 21 June 2021 for publications in English about women with uterine sarcoma treated with a fertility-sparing intervention. Thirty-seven studies were included for a total of 210 patients: 63 low-grade endometrial stromal sarcomas, 35 embryonal rhabdomyosarcomas of the cervix, 19 adenosarcomas, 7 leiomyosarcomas and 2 uterine tumors resembling an ovarian sex cord. Conservative treatment ensured pregnancy in 32% of cases. In terms of oncological outcomes, relapse was related to histology and the worst prognosis was reported for leiomyosarcoma, followed by low-grade endometrial stromal sarcoma, which relapsed in 71% and 54% of cases, respectively. The highest death rate was associated with leiomyosarcoma (57.1%). This study demonstrated that fertility-sparing treatments may be employed in selected cases of early stage uterine sarcoma. View Full-Text
Keywords: fertility-sparing; gynecological cancers; sarcomas; uterine cancers; assisted reproductive treatments fertility-sparing; gynecological cancers; sarcomas; uterine cancers; assisted reproductive treatments
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MDPI and ACS Style

Dondi, G.; Porcu, E.; De Palma, A.; Damiano, G.; De Crescenzo, E.; Cipriani, L.; Dirodi, M.; Ravegnini, G.; De Leo, A.; Nannini, M.; Ferioli, M.; Morganti, A.G.; Pantaleo, M.A.; De Iaco, P.; Perrone, A.M. Uterine Preservation Treatments in Sarcomas: Oncological Problems and Reproductive Results: A Systematic Review. Cancers 2021, 13, 5808. https://doi.org/10.3390/cancers13225808

AMA Style

Dondi G, Porcu E, De Palma A, Damiano G, De Crescenzo E, Cipriani L, Dirodi M, Ravegnini G, De Leo A, Nannini M, Ferioli M, Morganti AG, Pantaleo MA, De Iaco P, Perrone AM. Uterine Preservation Treatments in Sarcomas: Oncological Problems and Reproductive Results: A Systematic Review. Cancers. 2021; 13(22):5808. https://doi.org/10.3390/cancers13225808

Chicago/Turabian Style

Dondi, Giulia, Eleonora Porcu, Alessandra De Palma, Giuseppe Damiano, Eugenia De Crescenzo, Linda Cipriani, Maria Dirodi, Gloria Ravegnini, Antonio De Leo, Margherita Nannini, Martina Ferioli, Alessio G. Morganti, Maria A. Pantaleo, Pierandrea De Iaco, and Anna M. Perrone. 2021. "Uterine Preservation Treatments in Sarcomas: Oncological Problems and Reproductive Results: A Systematic Review" Cancers 13, no. 22: 5808. https://doi.org/10.3390/cancers13225808

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