Fertility-sparing management of low-grade endometrial stromal sarcoma

Although fertility preservation is not the current standard of care in patients with low-grade endometrial stromal sarcoma, it could be considered in women who wish to preserve their reproductive potential, and whose early-stage disease is small and confined. This approach should be considered an alternative and should be offered only under strict conditions, such as being an experienced reference center and with appropriate patient consent, where the risks and benefits of the treatment are clearly explained. The above conditions are crucial to guarantee safety and good outcomes during the complex process of fertility preservation. Candidates must be carefully selected and counseled on potential risks, benefits, and reproductive outcomes. Early evaluation and counseling by the reproductive endocrinology team should also be considered a priority and carried out early in the therapeutic process. Although the ideal fertility-preserving management of low-grade endometrial stromal sarcoma is yet to be defined, the current data are encouraging. More cases are necessary, as well as a longer follow-up, to define with greater clarity, safety, and efficacy the fertility-preserving therapeutic option. © 2023 BMJ Publishing Group. All rights reserved.