title: Effectiveness of high-dose progestin and long-term outcomes in young women with early-stage, well-differentiated endometrioid adenocarcinoma of uterine endometrium.
abstract: OBJECTIVE
  We assessed the effectiveness of high-dose progestins as a conservative treatment in young women with endometrial adenocarcinoma.
  
  
  METHODS
  We retrospectively reviewed the hospital data of patients with endometrial cancer that were managed conservatively. Of those women with grade 1 endometrioid endometrial adenocarcinoma, we included those who were younger than 40 years and in whom the disease was clinically confined to the endometrium. A complete response was defined pathologically as the absence of tissue with adenocarcinoma or hyperplasia.
  
  
  RESULTS
  Fourteen patients were included. Their mean age was 30.0 ± 4.8 years and the mean follow-up period was 47.3 ± 29.7 months. Twelve patients received 30-500 mg/day medroxyprogesterone acetate and two received 160 or 240 mg/day megestrol acetate. The median duration of treatment was 6 months (range 3-15 months) and 13 (93%) patients showed a complete response. Endometrial pathology reappeared in four patients (4/13, 31%) including two relapses, three of whom developed after the patients gave birth. Six patients used a combined oral contraceptive or a progestin-releasing intrauterine device as a maintenance therapy and experienced no recurrence. Four women (4/7, 57%) conceived successfully seven times with assisted-reproductive technology. No adverse effects of the progestins or tumor-related death were noted.
  
  
  CONCLUSIONS
  High-dose progestin therapy can be an effective conservative treatment in young patients with well-differentiated early-stage endometrial cancer. If patients wish to preserve their fertility even after they have completed childbearing, maintenance therapy with a cyclic oral contraceptive or a progestin-releasing intrauterine device may be an option to prevent recurrence.
authors.affiliation: Department of Obstetrics and Gynecology, College of Medicine, CHA University, 650-9, Yoksam-dong, Gangnam-gu, Seoul 135-913, Korea.
authors.forename: Hyun
authors.initials: H
authors.lastname: Park
authors.forename: Jun Min
authors.initials: JM
authors.lastname: Seok
authors.forename: Bo Sung
authors.initials: BS
authors.lastname: Yoon
authors.forename: Seok Ju
authors.initials: SJ
authors.lastname: Seong
authors.forename: Ji Young
authors.initials: JY
authors.lastname: Kim
authors.forename: Jeong Yun
authors.initials: JY
authors.lastname: Shim
authors.forename: Chong Taik
authors.initials: CT
authors.lastname: Park
mesh_terms: D000328:Adult; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage* / Q000627:therapeutic use; D018269:Carcinoma, Endometrioid / Q000188:drug therapy* / Q000473:pathology; D003278:Contraceptives, Oral, Hormonal / Q000627:therapeutic use; D005260:Female; D059247:Fertility Preservation; D005500:Follow-Up Studies; D006801:Humans; D007436:Intrauterine Devices, Medicated; D060046:Maintenance Chemotherapy; D017258:Medroxyprogesterone Acetate / Q000008:administration & dosage* / Q000627:therapeutic use; D019290:Megestrol Acetate / Q000008:administration & dosage* / Q000627:therapeutic use; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy*; D012189:Retrospective Studies; D013997:Time Factors; D014594:Uterine Neoplasms / Q000188:drug therapy* / Q000473:pathology; D055815:Young Adult
chemical_list: D018931:Antineoplastic Agents, Hormonal; D003278:Contraceptives, Oral, Hormonal; D017258:Medroxyprogesterone Acetate; D019290:Megestrol Acetate