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Prolonged Conservative Treatment of Endometrial Cancer Patients: More Than 1 Pregnancy Can Be Achieved
  1. Tamar Perri, MD*,,
  2. Jacob Korach, MD*,
  3. Walter H. Gotlieb, MD, PhD,
  4. Mario Beiner, MD*,
  5. Dror Meirow, MD,
  6. Eddie Friedman, MD§,
  7. Alex Ferenczy, MD and
  8. Gilad Ben-Baruch, MD*
  1. * Department of Gynecologic Oncology, Sheba Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel;
  2. Division of Gynecologic Oncology, McGill-Jewish General Hospital, Montreal, Quebec, Canada; Departments of
  3. IVF and
  4. § Pathology, Sheba Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; and
  5. Department of Pathology, McGill-Jewish General Hospital, Montreal, Quebec, Canada.
  1. Address correspondence and reprint requests to Tamar Perri, MD, Department of Gynecologic Oncology, Sheba Medical Center, 52621 Tel Hashomer, Israel. E-mail: tamarperri{at}gmail.com.

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.

  • Endometrial carcinoma
  • Progestins
  • Conservative treatment
  • Fertility preservation

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Footnotes

  • The authors declare that there are no conflict of interest and no financial support.

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