PROGESTIN ALONE AS PRIMARY-TREATMENT OF ENDOMETRIAL CARCINOMA IN PREMENOPAUSAL WOMEN - REPORT OF 7 CASES AND REVIEW OF THE LITERATURE

BACKGROUND. The standard treatment for endometrial carcinoma is stagin g laparotomy with total abdominal hysterectomy and bilateral salpingo- oophorectomy. In an attempt to preserve childbearing potential, select ed patients with endometrial carcinoma were treated with progestin alo ne as primary therapy. METHODS. Patients were identified through searc hes of tumor registries and solicitation of consulting gynecologic onc ologists at the affiliated institutions of the University of Californi a-Los Angeles Center for the Health Sciences, Only those patients with a diagnosis of endometrial carcinoma treated with progestin alone as primary therapy were included in the study. Independent pathologic rev iew was performed by a recognized expert gynecologic pathologist to ex clude cases of endometrial hyperplasia. A MEDLINE search was conducted to identify reports of similarly treated patients. RESULTS. Seven pat ients were treated with progestin alone for endometrial carcinoma at t he study institution. Fourteen additional patients were identified thr ough the literature search. Combining the data for all patients, 13 of 21 patients (62%) had an initial response to progestins. Three initia l responders later developed recurrent disease, one of whom was found to have extrauterine disease at laparotomy. Eight of 21 patients (38%) did not respond to progestins and underwent more definitive treatment . None of these patients later developed recurrent disease. Six viable infants were delivered of three patients after therapy. Nineteen of 2 1 patients were alive without evidence of disease at last follow-up. C ONCLUSIONS. The results of this study show that premenopausal women wi th endometrial carcinoma map be treated successfully with progestin th erapy alone as primary therapy to preserve childbearing potential. (C) 1997 American Cancer Society.