Abstract
Purpose
We assessed the effectiveness of high-dose progestins as a conservative treatment in young women with endometrial adenocarcinoma.
Methods
We retrospectively reviewed the hospital data of patients with endometrial cancer that were managed conservatively. Of those women with grade 1 endometrioid endometrial adenocarcinoma, we included those who were younger than 40 years and in whom the disease was clinically confined to the endometrium. A complete response was defined pathologically as the absence of tissue with adenocarcinoma or hyperplasia.
Results
Fourteen patients were included. Their mean age was 30.0 ± 4.8 years and the mean follow-up period was 47.3 ± 29.7 months. Twelve patients received 30–500 mg/day medroxyprogesterone acetate and two received 160 or 240 mg/day megestrol acetate. The median duration of treatment was 6 months (range 3–15 months) and 13 (93%) patients showed a complete response. Endometrial pathology reappeared in four patients (4/13, 31%) including two relapses, three of whom developed after the patients gave birth. Six patients used a combined oral contraceptive or a progestin-releasing intrauterine device as a maintenance therapy and experienced no recurrence. Four women (4/7, 57%) conceived successfully seven times with assisted-reproductive technology. No adverse effects of the progestins or tumor-related death were noted.
Conclusions
High-dose progestin therapy can be an effective conservative treatment in young patients with well-differentiated early-stage endometrial cancer. If patients wish to preserve their fertility even after they have completed childbearing, maintenance therapy with a cyclic oral contraceptive or a progestin-releasing intrauterine device may be an option to prevent recurrence.
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References
Evans-Metcalf ER, Brooks SE, Reale FR, Baker SP (1998) Profile of women 45 years of age and younger with endometrial cancer. Obstet Gynecol 91:349–354
Crissman JD, Azoury RS, Barnes AE, Schellhas HF (1981) Endometrial carcinoma in women 40 years of age or younger. Obstet Gynecol 6:699–704
Kim WK, Park ED (1994) Endometrial cancers in young women under the age of 40: a clinicopathologic study. Korean J Obstet Gynecol 37:1829–1838
Lee SE, Kim JW, Park NH, Song YS, Kang SB, Lee HP (2005) Contemporary trends of endometrial cancer in Korean women. Korean J Gynecol Oncol 16:215–220
Creasman WT, Morrow BN, Bundy BN, Homesley HD, Graham JE, Heller PB (1987) Surgical pathologic spread patterns of endometrial cancer. A Gynecologic Oncology Group Study. Cancer 60:2035–2041
Chan JK, Wu H, Cheung MK, Shin JY, Osann K, Kapp DS (2007) The outcomes of 27, 063 women with unstaged endometrioid uterine cancer. Gynecol Oncol 106:282–288
Emons G, Heyl W (2000) Hormonal treatment of endometrial cancer. J Cancer Res Clin Oncol 126:619–623
Ramirez PT, Frumovitz M, Bodurka DC, Sun CC, Levenback C (2004) Hormonal therapy for the management of grade 1 endometrial adenocarcinoma: a literature review. Gynecol Oncol 95:133–138
Jadoul P, Donnez J (2003) Conservative treatment may be beneficial for young woman with atypical endometrial hyperplasia or endometrial adenocarcinoma. Fertil Steril 80:1315–1324
Gotlieb WH, Beiner ME, Shalmon B, Korach Y, Segal Y, Zmira N, Koupolovic J, Ben-Baruch G (2003) Outcome of fertility-sparing treatment with progestins in young patients with endometrial cancer. Obstet Gynecol 102:718–725
Eftekhar Z, Izadi-Mood N, Yarandi F, Shojaei H, Rezaei Z, Mohagheghi S (2009) Efficacy of megestrol acetate (Megace) in the treatment of patients with early endometrial adenocarcinoma: our experiences with 21 patients. Int J Gynecol Cancer 19:249–252
Yahata T, Fujita K, Aoki Y, Tanaka K (2006) Long-term conservative therapy for endometrial adenocarcinoma in young women. Hum Reprod 21:1070–1075
Mountzios G, Pectasides D, Bournakis E, Pectasides E, Bozas G, Dimopoulos MA, Papadimitriou CA (2010) Developments in the systemic treatment of endometrial cancer. Crit Rev Oncol Hematol. doi:10.1016/j.critrevonc.2010.07.013
Jeyarajah AR, Gallagher CJ, Blake PR, Oram DH, Dowsett M, Fisher C, Oliver RT (1996) Long-term follow-up of gonadotrophin-releasing hormone analog treatment for recurrent endometrial cancer. Gynecol Oncol 63:47–52
Lentz SS, Brady MF, Major FJ, Reid GC, Soper JT (1996) High-dose megestrol acetate in advanced or recurrent endometrial carcinoma: a Gynecologic Oncology Group Study. J Clin Oncol 14:357–361
Thigpen JT, Brady MF, Alvarez RD, Adelson MD, Homesley HD, Manetta A, Soper JT, Given FT (1999) Oral medroxyprogesterone acetate in the treatment of advanced or recurrent endometrial carcinoma: a dose–response study by the Gynecologic Oncology Group. J Clin Oncol 17:1736–1744
Kounelis S, Kapranos N, Kouri E, Coppola D, Papadaki H, Jones MW (2000) Immunohistochemical profile of endometrial adenocarcinoma: a study of 61 cases and review of the literature. Mod Pathol 13:379–388
Yamazawa K, Hirai M, Fujito A, Nishi H, Terauchi F, Ishikura H, Shozu M, Isaka K (2007) Fertility-preserving treatment with progestin, and pathologic criteria to predict response, in young women with endometrial cancer. Hum Reprod 22:1953–1958
Signorelli M, Caspani G, Bonazzi C, Chiappa V, Perego P, Mangioni C (2009) Fertility-sparing treatment in young women with endometrial cancer or atypical complex hyperplasia: a prospective single-institution experience of 21 cases. BJOG 116:114–118
Han AR, Kwon YS, Kim DY, Kim JH, Kim YM, Kim YT, Nam JH (2009) Pregnancy outcomes using assisted reproductive technology after fertility-preserving therapy in patients with endometrial adenocarcinoma or atypical complex hyperplasia. Int J Gynecol Cancer 19:147–151
Hahn HS, Yoon SG, Hong JS et al (2009) Conservative treatment with progestin and pregnancy outcomes in endometrial cancer. Int J Gynecol Cancer 19:1068–1073
Ushijima K, Yahata H, Yoshikawa H et al (2007) Multicenter phase II study of fertility-sparing treatment with medroxyprogesterone acetate for endometrial carcinoma and atypical hyperplasia in young women. J Clin Oncol 25:2798–2803
Walsh C, Holschneider C, Hoang Y, Tieu K, Karlan B, Cass I (2005) Coexisting ovarian malignancy in young women with endometrial cancer. Obstet Gynecol 106:693–699
Mao Y, Wan X, Chen Y, Lv W, Xie X (2010) Outcomes of conservative therapy for young women with early endometrial adenocarcinoma. Fertil Steril 93:283–285
Montz FJ, Bristow RE, Bovicelli A, Tomacruz R, Kruman RJ (2002) Intrauterine progesterone treatment of early endometrial cancer. Am J Obstet Gynecol 186:651–657
Lee SY, Kim MK, Park H, Yoon BS, Seong SJ, Kang JH, Jun HS, Park CT (2010) The effectiveness of levonorgestrel releasing intrauterine system in the treatment of endometrial hyperplasia in Korean women. J Gynecol Oncol 21:102–105
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H. Park and J. M. Seok contributed equally to this study.
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Park, H., Seok, J.M., Yoon, B.S. et al. Effectiveness of high-dose progestin and long-term outcomes in young women with early-stage, well-differentiated endometrioid adenocarcinoma of uterine endometrium. Arch Gynecol Obstet 285, 473–478 (2012). https://doi.org/10.1007/s00404-011-1959-x
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DOI: https://doi.org/10.1007/s00404-011-1959-x