title: Fertility-Sparing Treatment of Early Endometrial Cancer and Complex Atypical Hyperplasia in Young Women of Childbearing Potential.
abstract: OBJECTIVE
  To evaluate oncologic and reproductive outcome with levonorgestrel-releasing intrauterine system combined with gonadotropin-releasing hormone agonist in women with grade 1 endometrial carcinoma, and the levonorgestrel monotherapy in women with complex atypical hyperplasia.
  
  
  METHODS
  A prospective study was conducted. We analyzed the clinical characteristics of 70 patients younger than 42 years (mean age, 33 years) with a diagnosis of complex atypical endometrial hyperplasia (AEH) or grade 1 endometrial adenocarcinoma who were treated with hormonal therapy at the Division of Gynecologic Oncology of P.A. Hertsen Moscow Cancer Research Institute from February 2009 to December 2012. Patients with complex AEH received monotherapy with levonorgestrel-releasing intrauterine system (Mirena, Shering, Finland; 52 mg). Patients with a diagnosis of grade 1 endometrial cancer were treated with levonorgestrel-releasing intrauterine system combined with gonadotropin-releasing hormone agonist (Zoladex; AstraZeneca UK Limited, UK; 3.6-mg depot). All the patients received hormonal therapy for a minimum of 6 months. Pretreatment evaluation consisted of transabdominal and transvaginal ultrasound in grayscale, color Doppler ultrasound, contrast-enhanced magnetic resonance imaging, cervical hysteroscopy, Pipelle endometrial biopsy, and morphological and immunohistochemical characteristics of the tissue.
  
  
  RESULTS
  Seventy patients were included in study analyses. Twenty three (72%) of 32 patients with adenocarcinoma and 35 (92%) of 38 patients with AEH had complete remission, defined as the absence of any carcinoma or hyperplasia on endometrial sampling specimens. Among these cases, 2 patients with adenocarcinoma and 1 patient with AEH had recurrence after their complete response. Nine patients had persistent disease. Eight patients had 10 conceptions, resulting in 8 live births.
  
  
  CONCLUSIONS
  The suggested conservative treatment strategy can be considered as a valid therapeutic option for young women of childbearing potential with atypical endometrial hyperplasia and grade 1 endometrial adenocarcinoma who wish to preserve their fertility and thus may be recommended as an alternative to hysterectomy. Close follow-up during and after the treatment period is strictly required.
authors.affiliation: *Gynecologic Oncology Division, and †Anatomical Pathology Division, P.A. Hertsen Moscow Cancer Research Institute, Moscow, Russian Federation.
authors.forename: Stanislav Mikhailovich
authors.initials: SM
authors.lastname: Pronin
authors.forename: Olga Valerievna
authors.initials: OV
authors.lastname: Novikova
authors.forename: Julia Yurievna
authors.initials: JY
authors.lastname: Andreeva
authors.forename: Elena Grigorievna
authors.initials: EG
authors.lastname: Novikova
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D000328:Adult; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D004714:Endometrial Hyperplasia / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D016889:Endometrial Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D059247:Fertility Preservation; D005500:Follow-Up Studies; D006801:Humans; D007247:Infertility, Female / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D009367:Neoplasm Staging; D011230:Precancerous Conditions / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D011247:Pregnancy; D011372:Progestins / Q000627:therapeutic use*; D011379:Prognosis; D011446:Prospective Studies
chemical_list: D018931:Antineoplastic Agents, Hormonal; D011372:Progestins