title: The fertility-sparing treatment in patients with endometrial atypical hyperplasia and early endometrial cancer: a debated therapeutic option.
abstract: Fertility-sparing treatment may represent a realist option for accurately selected young patients with endometrial atypical hyperplasia or well differentiated, early endometrial cancer. Oral progestins, and especially medroxyprogesterone acetate (MPA) and megestrol acetate with different doses and schedules, represent the most commonly used hormone agents in this clinical setting. Approximately three fourths of the women achieve a histologically documented complete response, with an mean response time of 12 weeks, but about one third of these subsequently developed a recurrence after a mean time of 20 months. The expression of receptor for progesterone receptor (PR), PTEN gene, DNA mismatch repair gene MLH1 and phospho-AKT on tissue specimens may be useful for selecting patients fit for a conservative management. Several successful pregnancies have occurred after a fertility-sparing treatment of endometrial atypical hyperplasia or endometrial cancer, more frequently with assisted reproductive technologies. The implementation of in vitro fertilisation techniques not only increases the chance of conception, but it may also decrease the interval to conception. The opportunity of a demolitive surgery after delivery or after childbearing being no longer required is a still debated issue. Large multicenter trials are strongly warranted to better define the selection criteria for a conservative treatment, endocrine regimen of choice, the optimal dosing, the duration of treatment and follow-up protocols. In any case, the patient should be accurately informed about the relatively high recurrence rates after complete response to hormone treatment and expectations for pregnancy.
authors: Department of Procreative Medicine, Division of Gynecology and Obstetrics, University of Pisa, via Roma 56, Pisa 56127, Italy. a.gadducci@obgyn.med.unipi.it
authors: Angiolo
authors: A
authors: Gadducci
authors: Nicoletta
authors: N
authors: Spirito
authors: Elena
authors: E
authors: Baroni
authors: Roberta
authors: R
authors: Tana
authors: Andrea Riccardo
authors: AR
authors: Genazzani
mesh_terms: D004714:Endometrial Hyperplasia / Q000188:drug therapy* / Q000235:genetics / Q000378:metabolism; D016889:Endometrial Neoplasms / Q000188:drug therapy* / Q000235:genetics / Q000378:metabolism; D004717:Endometrium / Q000378:metabolism / Q000473:pathology; D005260:Female; D005298:Fertility; D006801:Humans; D011372:Progestins / Q000627:therapeutic use*; D011980:Receptors, Progesterone / Q000235:genetics / Q000378:metabolism; D016896:Treatment Outcome
chemical_list: D011372:Progestins; D011980:Receptors, Progesterone