Research
Oncology
Combined medroxyprogesterone acetate/levonorgestrel–intrauterine system treatment in young women with early-stage endometrial cancer

https://doi.org/10.1016/j.ajog.2013.06.031Get rights and content

Objective

The purpose of this study was to evaluate the efficacy of the combined oral medroxyprogesterone acetate (MPA)/levonorgestrel-intrauterine system (LNG-IUS) treatment in young women with early-stage endometrial cancer who wish to preserve their fertility.

Study Design

A prospective observational study was conducted. The study population comprised women aged ≤40 years who were diagnosed with endometrioid endometrial cancer, grade 1, tumor size <2 cm presumably confined to the endometrium. A LNG-IUS was inserted in the uterine cavity of each woman, and all of the women received oral MPA (500 mg/d). Dilation was conducted every 3 months.

Results

From September 2008 to December 2012, 16 patients were enrolled. The overall complete remission rate was 87.5% (14/16 patients); the average time to complete remission was 9.8 ± 8.9 months (range, 3–35 months). In the initial 3 months of treatment, complete remission was observed in 25% of cases (4/16 patients), partial response in 25% (4/16), and no change in 50% (8/16); there were no cases of progressive disease. Three patients achieved pregnancies. The average follow-up period was 31.1 ± 11.8 months (range, 16–50 months), and there were no treatment-related complications.

Conclusion

Combined oral MPA/LNG-IUS treatment is considered to be effective and favorable for young patients with early-stage endometrial cancer who want to preserve their fertility.

Section snippets

Patients and Methods

A prospective observational study was conducted from September 2008 to December 2012; 16 patients with EC at CHA Gangnam Medical Center were enrolled. Inclusion criteria were ≤40 years old with the histologically proven well-differentiated endometrioid EC, tumor size <2 cm that was presumed International Federation of Gynecology and Obstetrics stage IA limited to the endometrium, and a strong desire to preserve their fertility.

The histologic diagnosis was made with dilation while the patient

Results

Sixteen eligible subjects were treated with combined oral MPA/LNG-IUS. None of them had any obstetric history; their mean age was 34.8 ± 4.3 years (range, 29–40 years), and their average body mass index was 24.4 ± 5.9 kg/m2 (range, 17.0–36.3 kg/m2). The overall complete remission rate was 87.5% (14/16 patients); the average time to complete remission was 9.8 ± 8.9 months (range, 3–35 months). In the initial 3 months of combined treatment, CR was observed in 25% of patients (4/16 patients); PR

Comment

During the last years, conservative treatments such as the administration of high-dose oral progesterone or progesterone-containing intrauterine system frequently have been proposed for early-stage EC.5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 19 Most studies have reported approximately 57-76% response rates for 100-800 mg of oral progesterone (megestrol acetate or MPA:MPA) per day. Nonetheless and unfortunately, such evidence is not sufficient, particularly for the purposes of

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The authors report no conflict of interest.

Cite this article as: Kim MK, Seong SJ, Kim YS, et al. Combined medroxyprogesterone acetate/levonorgestrel–intrauterine system treatment in young women with early-stage endometrial cancer. Am J Obstet Gynecol 2013;209:358.e1-4.

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