Conservative therapy for adenocarcinoma and atypical endometrial hyperplasia of the endometrium in young women: central pathologic review and treatment outcome

Kaku, Tsunehisa; Yoshikawa, Hiroyuki; Tsuda, Hitoshi; Sakamoto, Atsuhiko; Fukunaga, Masao; Kuwabara, Yoshinori; Hataeg, Masaki; Kudoh, Shoji; Kuzuya, Kazuo; Sato, Shinji; Nishimura, Toshinobu; Hiura, Masamichi; Nakano, Hitoo; Iwasaka, Tsuyoshi; Miyazaki, Kôji; Kamura, Toshiharu

doi:10.1016/s0304-3835(01)00462-1

Cited by 226 publications

(177 citation statements)

References 23 publications

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“…This approach is by no means a standard therapy and should not be recommended routinely, even when the patients desire. However, this approach has been supported by several reports in patients desiring to maintain fertility, despite the fact that the subsequent success rate of pregnancy is not necessarily high [55,56]. The initial response rate of MPA ranged from 55% to 100% for endometrial carcinoma and 70 to 100% for atypical hyperplasia [55,56].…”

Section: ) Progestin Therapymentioning

confidence: 99%

“…However, this approach has been supported by several reports in patients desiring to maintain fertility, despite the fact that the subsequent success rate of pregnancy is not necessarily high [55,56]. The initial response rate of MPA ranged from 55% to 100% for endometrial carcinoma and 70 to 100% for atypical hyperplasia [55,56]. In a recent multi-center study, Ushijima et al reported the results of 17 cases of atypical endometrial hyperplasia and 28 cases of endometrioid endometrial carcinoma [57].…”

Section: ) Progestin Therapymentioning

confidence: 99%

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Biological Roles of Estrogen and Progesterone in Human Endometrial Carcinoma - New developments in potential endocrine therapy for endometrial cancer -

et al. 2007

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Abstract. Endometrial carcinoma is one of the most common female pelvic malignancies. It is well known that uterine endometrial cell proliferation is under the control of both estrogen and progesterone. In this review, results of the recent studies on the biosynthesis and action of estrogen and progestin in normal endometrium and its disorders will be summarized and the new aspects of hormonal therapies in the patients with endometrial carcinoma will be discussed including its future prospectives. We reported that the enzymes responsible for intratumoral estrogen metabolism and biosynthesis are markedly different between human breast and endometrial carcinoma, although both of them are considered "estrogen-dependent malignancies". In addition, the biological significance of Progesterone receptor (PR) isoforms is considered to differ between endometrial and breast carcinomas. Clinical data concerning Hormone replacement therapy (HRT) and estrogen-dependent cancer risk also support these findings. These basic and clinical findings help to understand the biology and provide the new knowledge for prevention, diagnosis and treatment of human endomerial carcinoma. Specific endocrine treatment of endometrial carcinoma should be explored in future, although aromatase inhibitors are the most effective endocrine treatments of estrogen-responsive breast carcinoma. Retinoid, metabolities of vitamin A, and synthetic peroxisome proliferator-activated receptor (PPAR) γ ligands, which have been used for the treatment of insulin resistance in type II diabetes mellitus, may be the important candidates as drugs not only for prevention but also for possible endocrine treatment of endometrial carcinoma.

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Section: ) Progestin Therapymentioning

confidence: 99%

Section: ) Progestin Therapymentioning

confidence: 99%

Biological Roles of Estrogen and Progesterone in Human Endometrial Carcinoma - New developments in potential endocrine therapy for endometrial cancer -

et al. 2007

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“…Cases in which extrauterine metastasis occurred during conservative therapy, such as those reported by Imai et al and Ota et al, were also excluded because such cases can be treated by standard surgery. Thus, 13 cases of extrauterine recurrence after temporary remission are listed in Table 2 [3,[8][9][10][11][12][13][14]. Six of these cases had ovarian lesions as the extrauterine site.…”

Section: Discussionmentioning

confidence: 99%

Relapse as Advanced Carcinosarcoma Following Uterus-Preserving Therapy in a Patient with Early-Staged and Grade 1 Endometrioid Adenocarcinoma: A Case Report and Review of the Literature

Takeshita¹

2014

Gynecol Obstet (sunnyvale)

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Fertility-sparing treatment with high-dose progestin is now used in many young patients with early stage, grade 1 endometrioid adenocarcinoma. The response rate of this therapy is quite good, but the relapse rate is relatively high. If the site of recurrence is limited to the uterus, this may be treated with additional hormone therapy or hysterectomy. We recently experienced a case of a 30-year-old primigravida patient in whom intraperitoneal dissemination of carcinosarcoma occurred during follow-up after apparent complete remission of early-stage grade 1 endometrioid adenocarcinoma. We report the case as an example of a rare high-grade histology tumor that relapsed in an extrauterine site after primary remission had been achieved with high-dose progestin therapy. In a review of the literature through a MEDLINE search, we found 13 articles describing relapse in an extrauterine site, including 6 ovarian metastases, 4 retroperitoneal lymph node metastases, and 3 metastases to organs other than the ovary. Early stage, well-differentiated endometrioid adenocarcinoma of the uterine corpus is generally considered to have a good prognosis, but counseling of patients regarding life decisions is important, with provision of sufficient information on the possibility of extrauterine progression or disseminated recurrence.

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“…To summarize the domestic and overseas reports on progestin therapy applied as fertility-preserving therapy in 1997 through 2008, the lesions disappeared in 164 (75%) of the 218 cases of endometrial cancer (corresponding to G1 endometrioid adenocarcinoma, FIGO 1988 surgical stage Ia) in response to progestin therapy. Among these 164 cases showing disappearance of lesions, recurrence was later noted in 53 (36%) of the 148 cases where information on the presence/absence of recurrence was available (Table I) (14,(25)(26)(27)(28)(29)(30)(31)(32)(33)(34). When progestin therapy was applied to 47 cases of atypical endometrial hyperplasia, 42 cases (89%) showed disappearance of lesions, and 8 (19%) of these 42 cases later showed recurrence (Table II) (26,27,31,35).…”

Section: Progestin Therapy For Endometrial Cancermentioning

confidence: 99%

“…Among these 164 cases showing disappearance of lesions, recurrence was later noted in 53 (36%) of the 148 cases where information on the presence/absence of recurrence was available (Table I) (14,(25)(26)(27)(28)(29)(30)(31)(32)(33)(34). When progestin therapy was applied to 47 cases of atypical endometrial hyperplasia, 42 cases (89%) showed disappearance of lesions, and 8 (19%) of these 42 cases later showed recurrence (Table II) (26,27,31,35). Regarding the efficacy of progestin therapy on endometrial cancer, Montz et al reported that when progestin therapy was administered to cases of G1 endometrial cancer (FIGO 1988 surgical stage Ia) not indicated for surgery for reasons of influence of complications or preservation of fertility, the tumor was histologically rated as negative in 7 of the 11 cases at 6 months and 6 of the 8 cases at 12 months after the start of treatment (36).…”

Section: Progestin Therapy For Endometrial Cancermentioning

confidence: 99%

Progestin therapy for endometrial cancer: The potential of fourth-generation progestin (Review)

et al. 2012

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Abstract. Progestin preparations are made of synthetic progesterone and have often been used for hormone therapy in gynecological patients with endometriosis or endometrial cancer. Hormone therapy using progestin is considered to be one of the effective means of treatment particularly when dealing with endometrial cancer (an estrogen-dependent tumor). Numerous reports have been published concerning its efficacy in advanced or recurrent cases of atypical endometrial hyperplasia or endometrial cancer. Dienogest has been developed as a fourth-generation progestin for hormone therapy for endometriosis that can be used with high safety for long periods of time. In Japan, dienogest has been recommended as a first-line drug for endometriosis-associated pain. However, its antitumor activity has also been attracting close attention following a report that this drug suppressed the proliferation in vitro of endometrial cancer-derived cell lines which failed to respond to other progestins such as medroxyprogesterine acetate (MPA). The mechanism for antitumor activity of dienogest is considered to differ from the mechanism for antitumor activity of conventional progestin preparations used for treatment of endometrial cancer. This drug is expected to be clinically applicable as a new drug for the treatment of endometrial cancer. Contents

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Conservative therapy for adenocarcinoma and atypical endometrial hyperplasia of the endometrium in young women: central pathologic review and treatment outcome

Cited by 226 publications

References 23 publications

Biological Roles of Estrogen and Progesterone in Human Endometrial Carcinoma - New developments in potential endocrine therapy for endometrial cancer -

Biological Roles of Estrogen and Progesterone in Human Endometrial Carcinoma - New developments in potential endocrine therapy for endometrial cancer -

Relapse as Advanced Carcinosarcoma Following Uterus-Preserving Therapy in a Patient with Early-Staged and Grade 1 Endometrioid Adenocarcinoma: A Case Report and Review of the Literature

Progestin therapy for endometrial cancer: The potential of fourth-generation progestin (Review)

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