Hormonal Therapy for Women With Stage IA Endometrial Cancer of All Grades

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Abstract

OBJECTIVE:

To estimate the oncologic and pregnancy outcomes after oral progestin treatment of women of reproductive age with stage IA endometrial adenocarcinoma with stage IA, grade 1 differentiation with superficial myometrial invasion or stage IA, grade 2–3 differentiation with or without superficial myometrial invasion.

METHODS:

Medical records of 48 women (age 40 years or younger) with endometrioid adenocarcinoma of the uterus who met inclusion criteria and were treated conservatively with oral progestin were reviewed. Follow-up was performed primarily with imaging techniques followed by endometrial biopsy when indicated.

RESULTS:

The median age was 30 years (range, 23–40 years). Fourteen patients (29.2%) received daily oral megestrol acetate (median dose 160 mg per day, range 40–240 mg per day) and 34 (70.8%) received daily oral medroxyprogesterone acetate (median dose 500 mg per day, range 80–1,000 mg per day). Complete responses were observed for 37 patients (77.1%) after the median treatment duration of 10 months (range 3–20 months). Complete response rates were 76.5%, 73.9%, and 87.5% for patients with stage IA, grade 2–3 without myometrial invasion (n=17), for patients with stage IA, grade 1 with superficial myometrial invasion (n=23), and for patients with stage IA, grade 2–3 with superficial myometrial invasion (n=8), respectively (P=.731). Recurrence rates for 37 patients who achieved complete response after a median follow-up time of 48 months (range 7–136 months) were 23.1%, 47.1%, and 71.4%, respectively (P=.104). None experienced disease progression or died of the disease. Nine patients gave birth to 10 healthy newborns.

CONCLUSION:

Progestin treatment appears to be reasonably effective for patients with stage IA, grade 2–3 differentiation without myometrial invasion and patients with stage IA grade 1 differentiation with superficial myometrial invasion.

LEVEL OF EVIDENCE:

III

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