Conservative treatment of early endometrial cancer: Preliminary results of a pilot study

• Published in: Gynecologic oncology Vol. 120; no. 1; pp. 43 - 46
• Main Authors: Laurelli, Giuseppe, Di Vagno, Giovanni, Scaffa, Cono, Losito, Simona, Del Giudice, Maurizio, Greggi, Stefano
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2011
• Subjects: Adult; Antineoplastic Agents, Hormonal - administration & dosage; Combined Modality Therapy; Conservative treatment; Endometrial cancer; Endometrial Neoplasms - drug therapy; Endometrial Neoplasms - pathology; Endometrial Neoplasms - surgery; Female; Fertility; Hematology, Oncology and Palliative Medicine; Humans; Hysteroscopy; Hysteroscopy - methods; Intrauterine Devices, Medicated; Levonorgestrel - administration & dosage; Megestrol Acetate - administration & dosage; Neoplasm Staging; Obstetrics and Gynecology; Pilot Projects; Progestin therapy; Prospective Studies; Hysteroscopy; Endometrial cancer; Conservative treatment; Progestin therapy
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2010.10.004

Abstract 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.