Objective: The purpose of this study was to evaluate the safety of fertility-sparing treatment in young women with atypical hyperplasia (AH) or grade 1 endometrial cancer (EC). Design: This study was designed as a retrospective cohort study. Methods: All women ≤45 years of age with AH or grade 1 EC treated at Mayo Clinic between January 1, 1985 and December 31, 2005 were identified. Patient demographics, management, and follow-up data were retrospectively abstracted and analyzed. Results: Ninety-four women were treated for AH or grade 1 EC, 71 underwent immediate surgical treatment, and 23 elected to preserve fertility Among the latter, complete data were available for 21 patients (16 with AH and 5 with EC at initial diagnosis). During the first course, 11 received medroxyprogesterone acetate (MPA), 7 received megestrol acetate (MA), 1 received oral contraceptive pills, and 2 were observed. Response after the first course (median duration 6.1 months) was 71% overall; 81% in AH patients versus 40% in EC patients (p=0.11). All patients treated with MPA versus 43% treated with MA (p=0.01) responded. All 3 who did not respond after the first course responded to the second course with regression to benign endometrium (median duration 3.3 months). Overall response rate after two courses was 81% and 94.4% among those treated solely with progestins. Among those who continued fertility-preserving therapy after two courses, the recurrence rate was 39%; all patients with EC had a recurrence. All recurrences were confined to the uterus. Conclusions: Conservative management of AH and grade 1 EC appears to be an effective, but temporary alternative to hysterectomy for carefully selected, highly motivated women. Once childbearing is complete, women should be offered definitive surgical treatment.
ASJC Scopus subject areas
- Obstetrics and Gynecology