Conservative treatment of early endometrial cancer: preliminary results of a pilot study.
OBJECTIVE
This study evaluated the feasibility and efficacy of combined operative hysteroscopy (HSC) and hormone therapy as fertility-preserving treatment in a cohort of selected young women with early endometrial carcinoma (EC).


METHODS
Fourteen patients (median age 38 years, range 26-40) with FIGO stage IA (intramucous) EC wishing to preserve fertility were enrolled with the following inclusion criteria: age ≤40 years; no evidence of Lynch II syndrome; well-differentiated estrogen/progesterone receptor positive (ER+/PR+) endometrioid EC; no evidence of myoinvasion, multifocal tumor, node metastasis, ovarian mass; normal serum CA 125. Treatment consisted of hysteroscopic ablation of the lesion and the myometrial tissue below, followed by oral megestrol acetate (MA) 160 mg/day for 6 months (6 pts) or 52 mg levonorgestrel-medicated intrauterine device (LNG-IUD) for 12 months (8 pts).


RESULTS
With a median follow-up of 40 months (range 13-79), one patient recurred after 5 months from operative HSC and underwent definitive surgery, one patient showed an endometrial hyperplasia without atypia at the 3 and 6 month HSC control, with negative controls thereafter. Three patients have attempted to conceive and one of them conceived and term delivered a healthy baby.


CONCLUSIONS
Combined operative HSC and progestin therapy may have a role for safe and effective conservative management of early EC in selected patients wishing to preserve fertility.
Gynecologic Oncology, Istituto Nazionale dei Tumori G. Pascale, Naples, Italy.
Giuseppe
G
Laurelli
Giovanni
G
Di Vagno
Cono
C
Scaffa
Simona
S
Losito
Maurizio
M
Del Giudice
Stefano
S
Greggi
D000328:Adult; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D016889:Endometrial Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery*; D005260:Female; D005298:Fertility; D006801:Humans; D015907:Hysteroscopy / Q000379:methods; D007436:Intrauterine Devices, Medicated; D016912:Levonorgestrel / Q000008:administration & dosage*; D019290:Megestrol Acetate / Q000008:administration & dosage*; D009367:Neoplasm Staging; D010865:Pilot Projects; D011446:Prospective Studies
D018931:Antineoplastic Agents, Hormonal; D016912:Levonorgestrel; D019290:Megestrol Acetate