Conservative treatment may be beneficial for young women with atypical endometrial hyperplasia or endometrial adenocarcinoma

Jadoul, Pascale; Donnez, Jacques

doi:10.1016/s0015-0282(03)01183-x

Cited by 115 publications

(80 citation statements)

References 58 publications

(74 reference statements)

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“…15 Oral progesterone has been used to treat women with EH who wish to conserve the uterus. But some systemic side effects and poor compliance have been reported to be associated with oral progesterone.…”

Section: -4mentioning

confidence: 99%

The effectiveness of levonorgestrel releasing intrauterine system in the treatment of endometrial hyperplasia in Korean women

et al. 2010

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Objective: Levonorgestrel releasing intrauterine system (LNG-IUS) has been shown to treat patients with non-atypical & atypical endometrial hyperplasia (EH) successfully in many western studies. Our purpose was to examine the effectiveness of LNG-IUS in the treatment of Korean women with EH. Methods: We conducted a prospective observational study of 12 women diagnosed with EH and treated with LNG-IUS insertion between February 2007 and August 2009 at the Department of Gynecology of Gangnam CHA Hospital, CHA University School of Medicine. Baseline endometrial biopsies were done before insertion of LNG-IUS, and outpatient follow-up endometrial biopsies were undertaken at 3-month intervals after insertion of LNG-IUS. We investigated the regression rate and the time to regression. Results: Four patients had simple hyperplasia without atypia, 7 patients complex hyperplasia without atypia, and just 1 patient complex atypical hyperplasia. Complete regression of EH was achieved in all cases (100%, 12/12), with the significant proportion (66%, 8/12) achieving it within 3 months. The mean duration to regression was 4.5 months. All cases had regression within 9 months. In the case of complex atypical hyperplasia, the regression was attained at the 9th month after insertion of LNG-IUS. The mean follow-up duration was 12 months (range, 3 to 27 months). As long as LNG-IUS was maintained, the EH did not recur. Conclusion: LNG-IUS appears to be as highly effective in treating Korean women with EH.

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Section: -4mentioning

confidence: 99%

The effectiveness of levonorgestrel releasing intrauterine system in the treatment of endometrial hyperplasia in Korean women

et al. 2010

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“…It has been reported that conservative treatment followed by IVF enables such patients to achieve a successful pregnancy. These relatively good response rates are encouraging with respect to the possibility of conservative treatment by progestins in young patients (1)(2)(3)(4)(5). However, more than 30% of patients with endometrial adenocarcinoma displayed resistance to endocrine therapies at time of presentation.…”

Section: Introductionmentioning

confidence: 87%

“…Hysterectomy with bilateral oophorectomy usually leads to complete remission and long-term survival, although surgery deprives these patients of fertility potential (1,2). However, approximately 2-14% of patients who suffer from endometrial carcinoma are below aged 40.…”

Section: Introductionmentioning

confidence: 99%

“…However, approximately 2-14% of patients who suffer from endometrial carcinoma are below aged 40. The younger patients are frequently nulligravid with a history of infertility and a strong desire to preserve fertility (1)(2)(3)(4)(5). Therefore, a more conservative medical treatment is desirable in young patients who wish to preserve their fertility.…”

Section: Introductionmentioning

confidence: 99%

“…However, more than 30% of patients with endometrial adenocarcinoma displayed resistance to endocrine therapies at time of presentation. Additionally, most cancer patients that initially respond to progestin treatment will at some point develop resistance, resulting in tumor progression (2). Progestin therapy is limited by the development of resistance in the tumor.…”

Section: Introductionmentioning

confidence: 99%

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Response-specific progestin resistance in a newly characterized Ishikawa human endometrial cancer subcell line resulting from long-term exposure to medroxyprogesterone acetate

Zhao

et al. 2012

Oncology Letters

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Abstract. Progestins, particularly medroxyprogesterone acetate (MPA), have for a long time been used as conservative treatment for young patients with clinical stage I, grade I endometrial carcinoma. However, more than 30% of patients with endometrial adenocarcinoma display resistance to endocrine therapies at the time of presentation and most cancer patients that initially respond to progestin treatment will at some point develop resistance, resulting in tumor progression. The cellular mechanisms underlying acquired resistance to progestin are poorly understood. In order to investigate the molecular mechanisms whereby human endometrial adenocarcinoma develops resistance to progestin therapy, we have undertaken to develop human endometrial adenocarcinoma cell lines that are resistant to the growth-inhibitory effects of progestins in vitro. A progestin-resistant subcell line of Ishikawa cells was developed from Ishikawa human endometrial adenocarcinoma cells by stepwise selection in increasing concentrations of the synthetic progestin, MPA, over ten months. The doubling time of the progestin-resistant cells (34.18±3.15 h) grown routinely in the medium containing 10 µM MPA was not significantly different from the doubling time of the parent Ishikawa cells (35.14±2.68 h) grown in the absence of MPA (t=-0.331, P=0.762). Moreover, the effect of treatment with MPA shifted from suppression of growth and invasiveness, as observed in the parent Ishikawa cells, to stimulation of growth and invasiveness in the progestin-resistant Ishikawa cells. The positive rates of estrogen receptor a (ERα) and progesterone receptor B (PRB) of the progestin-resistant Ishikawa cells were significantly reduced, whilst the positive rate of ERβ was significantly enhanced compared to the parent Ishikawa cells. These differences were statistically significant (P<0.05). Our results indicate that long-term treatment with MPA in Ishikawa cells may give rise to a resistance effect to MPA. When the resistant subtype is acquired, treatment with MPA enhances cancer cell proliferation and invasiveness. The imbalance of ER and PR subtypes may contribute to the mechanisms involved in progestin resistance. Determination of the subtypes of ER and PR may provide important additional information on the hormone sensitivity of endometrial carcinoma.

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Sexuality and Fertility

Carter

Goldfarb

Sonoda

et al. 2017

The American Cancer Society's Principles of Oncology

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Conservative treatment may be beneficial for young women with atypical endometrial hyperplasia or endometrial adenocarcinoma

Cited by 115 publications

References 58 publications

The effectiveness of levonorgestrel releasing intrauterine system in the treatment of endometrial hyperplasia in Korean women

The effectiveness of levonorgestrel releasing intrauterine system in the treatment of endometrial hyperplasia in Korean women

Response-specific progestin resistance in a newly characterized Ishikawa human endometrial cancer subcell line resulting from long-term exposure to medroxyprogesterone acetate

Sexuality and Fertility

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