title: Prolonged conservative treatment of endometrial cancer patients: more than 1 pregnancy can be achieved.
abstract: BACKGROUND
  Preserving reproductive function in young patients with early endometrial cancer is an accepted concept today. The safety and feasibility of long-term conservative treatment, allowing more than 1 pregnancy, remain to be ascertained.
  
  
  METHODS
  This study was a retrospective chart review of a 27 women with endometrioid adenocarcinoma of the endometrium, who were treated conservatively at 2 tertiary-care institutions. Treatment comprised oral high-dose progestins with or without a levonorgestrel-releasing intrauterine device. Endometrial biopsy was repeated every 2 to 3 months.
  
  
  RESULTS
  Over 7.8 to 412 months (median, 57.4 months), tumors regressed completely in 24 (89%) of 27 patients and partially in 2 patients, with 79% responding within 1 to 17 months. Of the complete responders, 15 (62%) of 24 had a recurrence; 4 underwent hysterectomy, and 11 underwent subsequent progestational treatment. All 11 responded, and 3 subsequently conceived. After 2 to 4 years, 5 patients again had a recurrence, of whom 3 underwent hysterectomy. Overall, 2 patients developed ovarian adenocarcinoma. All patients are currently disease-free. Conception occurred in 14 (51.8%) of 27 patients, in 5 more than once. There were 17 live births, and 2 patients are pregnant.
  
  
  CONCLUSIONS
  According to our data, prolonged progestational therapy for early-stage endometrial adenocarcinoma, allowing women to conceive, is feasible and apparently does not alter clinical outcome. Patients should be advised of the high recurrence rate and possible concomitant ovarian malignancy.
authors.affiliation: Department of Gynecologic Oncology, Sheba Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. tamarperri@gmail.com
authors.forename: Tamar
authors.initials: T
authors.lastname: Perri
authors.forename: Jacob
authors.initials: J
authors.lastname: Korach
authors.forename: Walter H
authors.initials: WH
authors.lastname: Gotlieb
authors.forename: Mario
authors.initials: M
authors.lastname: Beiner
authors.forename: Dror
authors.initials: D
authors.lastname: Meirow
authors.forename: Eddie
authors.initials: E
authors.lastname: Friedman
authors.forename: Alex
authors.initials: A
authors.lastname: Ferenczy
authors.forename: Gilad
authors.initials: G
authors.lastname: Ben-Baruch
mesh_terms: D000328:Adult; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D018269:Carcinoma, Endometrioid / Q000188:drug therapy*; D016889:Endometrial Neoplasms / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000517:prevention & control; D007436:Intrauterine Devices, Medicated; D016912:Levonorgestrel / Q000627:therapeutic use*; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000601:surgery; D011247:Pregnancy; D011256:Pregnancy Outcome; D018873:Pregnancy Rate; D011372:Progestins / Q000627:therapeutic use*; D012074:Remission Induction / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D018931:Antineoplastic Agents, Hormonal; D011372:Progestins; D016912:Levonorgestrel