Elsevier

Obstetrics & Gynecology

Volume 102, Issue 4, October 2003, Pages 718-725
Obstetrics & Gynecology

Original research
Outcome of fertility-sparing treatment with progestins in young patients with endometrial cancer

https://doi.org/10.1016/S0029-7844(03)00667-7Get rights and content

Abstract

Objective

To evaluate the safety of fertility-sparing hormonal therapy for endometrial cancer in young patients.

Methods

We reviewed the clinical and pathologic records of patients diagnosed with endometrial adenocarcinoma before the age of 40, who were treated and followed over a 30-year period in the Division of Gynecologic Oncology. All patients who underwent conservative management with progestins (n = 13) are the subjects of this study.

Results

Follow-up was available for all 13 patients, with a mean follow-up of 82 months. All patients responded to treatment within a mean period of 3.5 months, with normal pathology on follow-up endometrial samplings. Six patients had a recurrence within a period extending between 19 and 358 months (median 40 months). Four patients were treated with a second course of progestins, and all had a histologic complete response. As of the time of preparation of this report, nine healthy infants had been born, and all the patients remained without evidence of disease.

Conclusion

Conservative management of well-differentiated endometrial carcinoma in young patients, combined with assisted reproductive technologies, if needed, does not seem to worsen the prognosis. This approach also provides the possibility of conceiving and carrying a normal pregnancy.

Section snippets

Material and methods

We retrospectively reviewed the charts of premenopausal women, diagnosed and treated for endometrial carcinoma over a 30-year period (1970–2000) in the Division of Gynecologic Oncology of a tertiary care center. All the patients who underwent fertility-sparing management with the use of progestins are the subjects of this report. We reviewed their inpatient, outpatient, and oncology charts and extracted relevant clinical information. Follow-up was available for all of the patients. Using the

Results

Out of 75 premenopausal patients, 13 (18%) who were diagnosed with endometrial carcinoma received progestins as the primary treatment modality for their cancer. The clinical characteristics of these patients are presented in Table 1. Age at presentation ranged from 23 to 40 years, with a mean age of 31 years. None of the patients had a family history consistent with hereditary non-polyposis colon cancer (HNPCC). All patients were white, nulliparous, and none suffered from hypertension or

Discussion

Endometrial carcinoma, especially in young patients, seems to have a favorable prognosis and to be highly hormone dependent. As early as the late 1960s, progestative treatment was reported in two patients with well-differentiated endometrial carcinoma. One patient went into regression and then became pregnant twice (Table 3).6 Since then, various studies (most of them case reports for a total of 88 patients; Table 3) have been published, but follow-up in these studies is limited (mean 32

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