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