title: A prospective study of fertility-sparing treatment with megestrol acetate following hysteroscopic curettage for well-differentiated endometrioid carcinoma and atypical hyperplasia in young women.
abstract: OBJECTIVE
  To investigate the feasibility and efficacy of curettage with hysteroscopy followed by megestrol acetate (MA) for well-differentiated endometrioid carcinoma (EC) confined to the endometrium and for atypical hyperplasia (AH) in young women.
  
  
  METHODS
  Fourteen patients with EC and 12 patients with AH were prospectively enrolled in this study. All of the patients received at least 12 weeks of oral MA (160 mg/day) following thorough curettage with hysteroscopy. The response was assessed histologically every 12 weeks. The primary endpoint was the complete response rate. Adverse events, pregnancy rates and recurrence rates were secondary end points.
  
  
  RESULTS
  Twenty-one (80.8 %) patients responded to treatment. The median time to response was 12 weeks. After a median follow-up of 32 months, 6 patients had recurrences. Significantly, more patients with infertility or PCOS experienced recurrence (P = 0.040, P = 0.015). Eight patients attempted to conceive after complete response; two spontaneous conceptions and one normal delivery were achieved. No disease-related or treatment-related deaths were observed.
  
  
  CONCLUSIONS
  Fertility-sparing treatment with MA following entirely hysteroscopic curettage is effective, demonstrating the least toxicity for rigorously selected young women with well-differentiated EC confined to the endometrium or with AH; however, close follow-up is required for the potential consequences of improper patient selection and a substantial rate of recurrence.
authors: Department of Gynecologic Oncology, Fudan University Shanghai Cancer Centre, NO. 270 Dong'an Road, Shanghai, 200032, China, shanboer@hotmail.com.
authors: Bo-er
authors: BE
authors: Shan
authors: Yu-lan
authors: YL
authors: Ren
authors: Jian-min
authors: JM
authors: Sun
authors: Xiao-yu
authors: XY
authors: Tu
authors: Zhao-xia
authors: ZX
authors: Jiang
authors: Xing-zhu
authors: XZ
authors: Ju
authors: Rong-yu
authors: RY
authors: Zang
authors: Hua-ying
authors: HY
authors: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D018269:Carcinoma, Endometrioid / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D003475:Curettage; D016889:Endometrial Neoplasms / Q000473:pathology / Q000628:therapy*; D004717:Endometrium / Q000473:pathology*; D005240:Feasibility Studies; D005260:Female; D059247:Fertility Preservation; D006801:Humans; D006965:Hyperplasia / Q000473:pathology / Q000628:therapy; D015907:Hysteroscopy; D019290:Megestrol Acetate / Q000627:therapeutic use*; D009364:Neoplasm Recurrence, Local / Q000628:therapy*; D011247:Pregnancy; D018873:Pregnancy Rate; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D018931:Antineoplastic Agents, Hormonal; D019290:Megestrol Acetate