The role of hormones for the treatment of endometrial hyperplasia and endometrial cancer.
OBJECTIVE
Hormone therapy has been palliative for advanced/ recurrent endometrial cancer. High remission rates are seen in well-selected stage I, grade 1 endometrial cancer of young women using hormone therapy (usually progestins) as fertility-preserving treatment. Many other hormones, such as gonadotropin-releasing hormone analogs (GnRHa), selective estrogen receptor modulators, aromatase inhibitors, intrauterine progestins, and others are potential modalities. This review updates the recent publications in this area.


RESULTS
Two reports investigating different scheduling of tamoxifen and progestins indicated that tamoxifen may be a valuable adjunct to progestin therapy. GnRHa has been used adjunctively to tamoxifen as second-line hormone therapy for fertility sparing after progestin failed. Aromatase inhibitors have shown their potential in treating endometrial cancer and endometrial hyperplasia as single agent or in combination with progestins. Intrauterine progestins seem efficacious in treating endometrial hyperplasia; its applications on endometrial cancer patients, however, have been limited to postmenopausal women with poor surgical risk.


CONCLUSIONS
Translational research based on molecular mechanisms is mandatory to a more appropriate utilization of hormone therapy. The role of dose, scheduling, route of administration of progestins as well as the addition of other hormonal agents should be further explored by well designed randomized controlled trials.
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan. laich46@adm.cgmh.org.tw
Chyong-Huey
CH
Lai
Huei-Jean
HJ
Huang
D047072:Aromatase Inhibitors / Q000627:therapeutic use; D004714:Endometrial Hyperplasia / Q000188:drug therapy*; D016889:Endometrial Neoplasms / Q000188:drug therapy*; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000627:therapeutic use; D006728:Hormones / Q000627:therapeutic use*; D006801:Humans; D010166:Palliative Care; D011372:Progestins / Q000627:therapeutic use; D020845:Selective Estrogen Receptor Modulators / Q000627:therapeutic use
D047072:Aromatase Inhibitors; D006728:Hormones; D011372:Progestins; D020845:Selective Estrogen Receptor Modulators; D007987:Gonadotropin-Releasing Hormone