Progestogen treatment options for early endometrial cancer

Please cite this paper as: Cade T, Quinn M, Rome R, Neesham D. Progestogen treatment options for early endometrial cancer. BJOG 2010;117:879–884.

Objective  Premenopausal women with early endometrial cancer may wish to maintain their fertility, and for some patients non-surgical treatment options may be attractive. We have examined our own experience with such patients, as there are limited published data so far to support clear guidelines in this area.

Design  Retrospective analysis of a case series.

Setting  Case series from a specialist gynaecological oncology unit in a major tertiary referral hospital.

Sample  Sixteen patients receiving progestogen therapy for stage-1 endometrial cancer.

Methods  We reviewed our experience of all patients receiving progestogen therapy for stage-1 endometrial cancer, and we particularly examined their cancer-free outcome and fertility potential.

Main outcome measures  Response to treatment, duration of response, and subsequent pregnancies.

Results  Of the 16 patients investigated, four received an oral progestogen, five received the levonorgestrel-releasing intrauterine system (Mirena), and seven received both forms of treatment. Ten patients (63%) responded to treatment, with a median time to response of 5.5 months. Six patients did not respond to treatment, but all were either early in treatment or opted for surgical management before the average time of response. No patient who responded had a later recurrence. The mean total follow-up time was 27 months (range 3–134 months), with no patient deaths. Three patients had successful pregnancies, with one patient having two children.

Conclusions  This form of treatment appears to be a realistic treatment option in selected patients in the closely supervised environment of a specialist gynaecological oncology unit.