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Eur Rev Med Pharmacol Sci. 2012 Dec;16(14):1934-7.

Fertility-sparing treatment of endometrial cancer precursors among young women: a reproductive point of view.

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  • 1Department of Obstetrics, Sapienza University of Rome, Rome, Italy. enzo.ricciardi@uniroma1.it

Abstract

BACKGROUND:

Early-stage endometrial cancer and complex atypical hyperplasia are treated with hysterectomy and bilateral salpingo-oophorectomy. An emerging issue among younger women affected is the possibility of a fertility-sparing treatment with progestative therapy and close follow-up.

AIM:

To assess the possibility of conceiving after a diagnosis of atypical endometrial hyperplasia among women younger than 40 years old, in term of delaying definitive treatment and achieving pregnancy.

MATERIALS AND METHODS:

15 women younger than 40 years old with complex CAH or early carcinoma of the endometrium and a wish to preserve fertility. Progestins were administered orally for at least a 12 weeks period. Endometrial biopsies were used at follow-up.

RESULTS:

In 11 women, a complete pathological remission of the disease was observed. 4 pregnancies were attained in 4 women. 3 showed progression and underwent definitive surgery at 18 months. 1 showed no response at 24 months and 3 cycles and was counseled to receive a hysterectomy.

CONCLUSIONS:

A conservative approach in patients younger than 40 years appears a valid option, and a progestative therapy trial should be attempted whether a valid consensus is attained. Considering the risk to find AEH at biopsies and eventually a carcinoma at hysterectomy (25% of cases) a careful management is strictly required.

PMID:
23242719
[PubMed - indexed for MEDLINE]
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