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Fertility-Preserving Treatment in Young Women With Endometrial Adenocarcinoma: A Long-Term Cohort Study
  1. Chin-Jung Wang, MD*,
  2. Angel Chao, MD, PhD,,
  3. Lan-Yan Yang, PhD,§,
  4. Swei Hsueh, MD,,
  5. Yu-Ting Huang, MD,
  6. Hung-Hsueh Chou, MD,,
  7. Ting-Chang Chang, MD, and
  8. Chyong-Huey Lai, MD,
  1. * Divisions of Gynecologic Endoscopy and
  2. Gynecologic Oncology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital and Chang Gung University;
  3. Gynecologic Cancer Research Center and
  4. §Biostatistics and Informatics Unit, Clinical Trial Center, Chang Gung Memorial Hospital; and Departments of
  5. Pathology and
  6. Radiology, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.
  1. Address correspondence and reprint requests to Chyong-Huey Lai, MD, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou, 5 Fu-Shin St, Kueishan, Taoyuan 333, Taiwan. E-mail: sh46erry{at}ms6.hinet.net.

Abstract

Objective Growing evidence suggests that fertility-preserving treatment is feasible for young women with early-stage, low-grade endometrial carcinoma. However, published data on their long-term outcomes and prognostic factors remain scanty. We aimed to investigate the outcomes of young women receiving fertility-preserving treatment.

Methods Between 1991 and 2010, the outcomes of young women with grade 1 endometrioid endometrial carcinoma at presumed stage IA (without myometrial invasion) who underwent fertility-preserving treatment of megestrol acetate 160 mg/d with or without other hormonal agents were retrospectively analyzed.

Results We identified 37 eligible patients (median age, 32 years; range, 18–40 years). The median follow-up time was 78.6 months (range, 19.1–252.8 months). Complete response (CR) lasting more than 6 months was achieved in 30 (81.1%) women. Responders were significantly younger than nonresponders (P = 0.032). Of the 30 women who had a CR, 15 (50.0%) had disease recurrence. The 5-, 10-, and 15-year cumulative recurrence-free survival rates were 51.0%, 51.0%, and 34.0%, respectively. Notably, those recurred were significantly older (P = 0.003), and the time to CR was significantly longer (P = 0.043) than those without recurrence. One patient developed late recurrences at 156 months, and 2 patients developed ovarian metastasis (6 and 137 months from diagnosis). All the patients are currently alive.

Conclusions This study demonstrates the feasibility of high-dose megestrol acetate–based therapy for fertility preservation. The substantial risk of late recurrences highlights the need for long-term follow-up studies of large sample sizes with in-depth tumor and host molecular signatures.

  • Endometrial carcinoma
  • Megestrol acetate
  • Young age
  • Fertility-preserving treatment
  • Hysteroscopy
  • Long-term follow-up

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Footnotes

  • Supported by grants from the National Science Council–Taiwan (NSC101-2314-B-182-043 to C.-J.W.) and the Chang Gung Medical Foundation (CMRPG391442 and BMRPG3A0011 to C.-H.L.).

  • The authors declare no conflicts of interest.

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