Fertility-preserving treatment in young patients with endometrial adenocarcinoma.
BACKGROUND
Hormone therapy alone for early-stage, low-grade endometrial carcinoma arising in young women has been reported occasionally in case reports or small series. However, a comprehensive guideline for selection, treatment, and follow-up is not available as yet.


METHODS
In the current study, the authors' evaluated the outcome of a cohort of young women with clinically diagnosed endometrial adenocarcinoma Stage IA, Grade 1 who were selected for fertility-preserving treatment by stringent staging procedures and treated in a standard protocol using combinations of megestrol acetate, tamoxifen, and gonadotropin-releasing hormone analog (GnRHa).


RESULTS
Nine eligible patients were treated between 1991 and 1999. The median age of the patients was 32 years (range, 30-39 years). Of the 9 patients, 8 (88.9%) achieved complete remission after hormone therapy. Four patients had ever conceived (two patients had three term pregnancies and underwent consolidation hysterectomy after completion of family planning). Only one patient underwent hysterectomy for failure to respond, whose tumor was estrogen receptor (ER)/progesterone receptor (PgR) positive by immunostaining but negative by ligand-binding method. Another patient, whose tumor was ER negative/PgR positive, had residual carcinoma on the first assessment and achieved complete remission after replacement of tamoxifen with a GnRHa. Four responders later developed recurrent endometrial carcinoma. One underwent immediate hysterectomy. Two were successfully re-treated with hormone therapy, but the other did not respond and underwent hysterectomy. All nine patients have been alive without evidence of disease 25-113 (median, 69) months from initial diagnosis.


CONCLUSIONS
The treatment strategy described in the current study is feasible. A larger multicenter trial of fertility-preserving treatment is warranted for nulliparous young patients with well selected Stage I, Grade 1, endometrial adenocarcinoma.
Wang
Chen-Bin
CB
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.
Wang
Chin-Jung
CJ
Huang
Huei-Jean
HJ
Hsueh
Swei
S
Chou
Hung-Hsueh
HH
Soong
Yung-Kuei
YK
Lai
Chyong-Huey
CH
D000230:Adenocarcinoma / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D015331:Cohort Studies; D018450:Disease Progression; D016889:Endometrial Neoplasms / Q000188:drug therapy* / Q000378:metabolism / Q000473:pathology; D005260:Female; D005298:Fertility / Q000502:physiology*; D007987:Gonadotropin-Releasing Hormone / Q000008:administration & dosage / Q000031:analogs & derivatives; D006801:Humans; D008535:Megestrol / Q000008:administration & dosage; D019290:Megestrol Acetate / Q000008:administration & dosage; D010388:Pelvis / Q000000981:diagnostic imaging; D011379:Prognosis; D011960:Receptors, Estrogen / Q000378:metabolism; D011980:Receptors, Progesterone / Q000378:metabolism; D013629:Tamoxifen / Q000008:administration & dosage; D016896:Treatment Outcome; D014463:Ultrasonography
D011960:Receptors, Estrogen; D011980:Receptors, Progesterone; D013629:Tamoxifen; D007987:Gonadotropin-Releasing Hormone; D008535:Megestrol; D019290:Megestrol Acetate