Elsevier

Gynecologic Oncology

Volume 95, Issue 1, October 2004, Pages 133-138
Gynecologic Oncology

Hormonal therapy for the management of grade 1 endometrial adenocarcinoma: a literature review

https://doi.org/10.1016/j.ygyno.2004.06.045Get rights and content

Abstract

Objective

We reviewed reported cases of grade 1 endometrial adenocarcinoma that were conservatively managed with hormonal therapy in an effort to identify the most effective treatment regimen.

Methods

We searched MEDLINE and other databases for English-language articles describing patients with grade 1 endometrial adenocarcinoma who were treated with hormonal therapy. The search included articles published between January 1966 and December 2003. The following key words were used: endometrial cancer, uterine cancer, adenocarcinoma, hormones, progesterone, medroxyprogesterone acetate, megestrol acetate, conservative therapy, fertility, and female. A total of 79 articles were found. Studies were excluded for the following reasons: advanced stage, metastatic or recurrent disease, progestin use after radiation, chemotherapy, or surgery, concurrent with radiation therapy or chemotherapy, administration of progestin other than orally or intramuscularly, tumor confined to a polyp, grade 2 or 3 disease, undocumented grade, nonendometrioid histology, progestin use in conjunction with ovarian wedge resection or other hormones, and hyperplasia. Our study ultimately included 81 patients in 27 articles.

Results

Sixty-two patients (76%) responded to treatment. The median time to response was 12 weeks (range, 4–60 weeks). Fifteen patients (24%) who initially responded to treatment recurred. The median time to recurrence was 19 months (range, 6–44 months). Ten (67%) of the patients with recurrence ultimately underwent total abdominal hysterectomy. Residual endometrial carcinoma was found in six patients (60%). Nineteen patients never responded. Twenty patients were able to become pregnant at least once after completing treatment. The median follow-up was 36 weeks (range, 0 weeks–30 years). No patients died of their disease.

Conclusion

The majority of patients reported with well-differentiated endometrial adenocarcinoma who undergo conservative treatment with a progestational agent respond to treatment. When an initial response is not achieved or when disease recurs, carcinoma extending beyond the uterus is rare.

Introduction

Endometrial adenocarcinoma is the most common gynecologic malignancy diagnosed in women in the United States—an estimated 43,200 cases of cancer of the uterine corpus are expected to be diagnosed in 2004 [1]. Typically, endometrial carcinoma is a disease of postmenopausal women. However, approximately 5% of women with this disease are diagnosed before the age of 40 years, and 20–25% are diagnosed before menopause [2]. It has previously been shown that endometrial adenocarcinomas diagnosed in young women are typically associated with good prognosis because of early stage and high tumor differentiation at diagnosis [3], [4].

The treatment generally recommended for patients diagnosed with endometrial adenocarcinoma is a total abdominal hysterectomy, with staging depending on risk factors. This option may be unacceptable to women who are diagnosed with endometrial cancer before completing childbearing and may not be feasible in women who suffer from multiple medical comorbidities and who are at high risk for surgical complications. Multiple reports have proposed that patients with early clinical stage and low grade may be treated conservatively with hormonal therapy [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31].

We reviewed reports of patients with grade 1 endometrial adenocarcinoma who were treated conservatively with hormonal therapy in an effort to evaluate outcomes after this approach. Such outcomes information would help physicians counsel patients regarding this treatment option.

Section snippets

Methods

We performed an electronic literature search to identify English-language articles on patients diagnosed with grade 1 endometrial adenocarcinoma who were treated with hormonal therapy. The databases searched were: MEDLINE [searched using both Ovid and PubMed interfaces], CancerLit [searched using the Ovid interface], and Current Contents. The searches were limited to studies published between January 1966 and December 2003. The following key words were used: endometrial cancer, uterine cancer,

Results

The median patient age was 30.5 years (range, 15–86 years). Some articles that reported on more than one patient stated only a mean age for all the patients described in the article rather than the actual age of each patient. In these 19 cases, each patient's age was assumed to be the mean age. Of the 81 patients included in this review, 4 (5%) were postmenopausal at the time of their initial treatment. Fifty (62%) of the 81 patients were diagnosed by dilatation and curettage (D&C), 4 patients

Discussion

One of the first reports on the successful use of progestational agents in the treatment of patients with advanced or recurrent endometrial carcinoma was published by Kelly and Baker in 1961 [32]. In a subsequent report, Podratz et al. [33] found that progestational agents induced an objective response in 11% of 155 patients with advanced primary or recurrent endometrial carcinoma. In that study, the response rates decreased with decreasing tumor differentiation, and survival was highly

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