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  • Title: [Conservative treatment of endometrial cancer as a way to preserve fertility. Five-year experience at Instituto Nacional de Perinatilogía Isidro Espinoza de los Reyes].
    Author: Arteaga Gómez AC, Castellanos Barroso G, Márquez Acosta G.
    Journal: Ginecol Obstet Mex; 2012 Jun; 80(6):394-9. PubMed ID: 22826967.
    Abstract:
    BACKGROUND: Progestins have been used in the treatment of advanced and metastatic endometrial cancer since the early 1960s. There is evidence that progestins can be used in fertility-preserving treatments in young women diagnosed with well-differentiated clinical stage 1A(EC1A) endometrioid type endometrial carcinoma. OBJECTIVE: Describe a fertility preservation treatment in women with primary infertility and EC1A endometrioid type endometrial carcinoma. PATIENTS AND METHODS: A historical cohort study. We analyzed 6 cases of women under 35 years assisted at the Oncology and Reproductive Medicine Department of the Instituto Nacional de Perinatologia of Mexico who met our inclusion criteria. Five women were treated with 500 mg medroxyprogesterone acetate (MPA) every other day; one woman was treated with 40 mg/day megestrol acetate (MGA). The treatment was continued to a maximum period of 11 months, provided that women gave good response to the treatment. The change in endometrial histology was assessed at four and six months of treatment. The primary endpoint was pathological complete response (CR). RESULTS: Follow-up time averaged 31 months; 66.6% of women responded to the initial hormone treatment; the remaining 33.4% responded to a second period of progesterone with histology in endometrial biopsy negative for cancer. Average response time was 6.8 months. Two patients had recurrence at an average of 19.5 months. Endometrial routine was performed with a disease-free interval of 15 to 24 months during which assisted reproductive technologies (ART) could be applied. Two patients achieved full-term pregnancy thanks to ART. The remaining patients did not continue with ART on their own initiative. CONCLUSIONS: In young women diagnosed with well-differentiated endometrioid EC1A carcinoma, the fertility-preserving treatment with progestin may be proposed together with strict selection and close monitoring of the patient.
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