Fertility sparing treatment in young patients with early endometrial adenocarcinoma

Abstract

Objective: The aim of this study was to evaluate fertility-sparing therapy in young patients with endometrial carcinoma. Methodology: This prospective study was carried out on 8 patients with clinical and radio-graphic stage IA, well differentiated endometrioid adenocarcinoma of the endometrium in Alzahra hospital, Tabriz, Iran. Treatment comprised high-dose megestrol acetate. Dilatation and curettage was repeated every three months. Results: The mean age of the patients was 30 (SD,3.21) years (range 24-35). Of the 8 patients, 7 (87.5%) achieved complete response. The mean time to response was 6.5 months (range 3-9). Of the complete responders, 3 of 7(42.8%) had recurrence; one patient underwent immediate hysterectomy, and 2 were successfully treated with second-line therapy and both subsequently conceived. Conception occurred in 3 of 7 patients (42.8%), in two more than once, However successful pregnancy occurred only in two patients. One patient developed Concomitant ovarian adenocarcinoma. Conclusions: High dose progestin therapy can be an effective fertility-sparing treatment in young patients with well differentiated stage IA endometrial endometrioid cancer confined to endometrium. However, close follow up is required because of risks of conservative treatment.

Fertility-preserving treatment in patients with early-stage endometrial cancer

“…In this study, [6–16] progestin therapy contained a variety of progestin types such as MPA, MA, D, norethindrone acetate lynestrenol, and natural progesterone. The species and doses (MPA range, 10–1500 mg/d; MA range, 30–320 mg/d), duration of treatment (range,1–15 months), and follow-up time (range, 5–358 months) varied greatly.…”

“…In this study, [6][7][8][9][10][11][12][13][14][15][16] progestin therapy contained a variety of progestin types such as MPA, MA, D, norethindrone acetate lynestrenol, and natural progesterone. The species and doses 2007) [8] 22 14 8 __ 4 3 __ 2-6.5 ART 2, N 1 Yamazawa,K.…”

Conservative re‐treatment of women with atypical endometrial hyperplasia and early endometrial carcinoma: We can hope, at least

“…A total of 492 women (189 [42.1%] AEH and 260 [57.9%] EEC) were assessed in the included studies. Twelve studies were retrospective 12,26–32,34,37–39 and three studies were prospective 33,35,36 . Age ranged from 16 to 47 years and body mass index (calculated as weight in kilograms divided by the square of height in meters) from 16.7 to 66.…”

“…A third limitation might lie in the above‐mentioned impossibility to perform sub‐group analyses based on the type of conservative re‐treatment (established or even experimental). In particular, outcomes of established methods different from oral progestins were not evaluable because of the presence of an eligible patient from only two included studies, 12,28 whereas outcomes of experimental re‐treatments could not be pooled because of the inhomogeneity in the included studies 26,30,33 …”

“…Ten studies were included in the meta-analysis 26,27,31,32,[34][35][36][37][38][39] as five studies were excluded from the analyses. In particular, one study was excluded because it did not report the type of conservative re-treatment, 29 one study because it used oral progestin + gonadotropin-releasing hormone (GnRH) agonists as a conservative re-treatment, 33 one study because it used hysteroscopic resection + GnRH agonists as a conservative re-treatment, 30 and two studies 12,28 because they reported data about conservative re-treatment for a single patient. Regarding recurrence, four other studies were excluded from analysis 26,27,31,34 because data about recurrence was not reported 27,31 or not extractable for patients re-treated with established methods; 26,34 hence, a total of six studies were included in the recurrence analysis.…”