OBJECTIVE: To estimate disease regression, persistence, and progression in women with complex endometrial hyperplasia and stage I endometrial carcinoma treated with a levonorgestrel-releasing-intrauterine system or oral progesterone.
METHODS: Records of all patients who received progestin therapy for endometrial hyperplasia or early-stage endometrioid cancer between January 1999 and July 2011 were reviewed. Demographic data (age, body mass index), presentation, treatment modality and rationale, rates of response, recurrence, and salvage surgery were collected and compared using Student’s t and χ2 tests. Fertility outcomes when available were analyzed.
RESULTS: One hundred eighty-six women received primary hormone therapy for endometrial hyperplasia or cancer. Of these, 153 had adequate follow-up without surgery or radiation as part of primary treatment. Average age at diagnosis was 49.6 years (range 22–92 years). The most common reasons cited for hormone therapy were medical comorbidities (46%) and fertility (21%). Patients with hyperplasia compared with cancer had significantly different complete response (66–70% compared with 6–13%), initial response with recurrence (11–23% compared with 19–30%), and no response rates (11–19% compared with 57–75%), respectively (P<.001). Outcomes were not significantly different between the levonorgestrel-releasing intrauterine system and oral progesterone among patients with cancer at all time points. In patients with hyperplasia, outcomes were not significantly different except during the 9-month to 12-month assessment where those who received systemic hormones were less likely to have disease persistence or progression compared with patients who had levonorgestrel-releasing intrauterine systems. Three patients achieved pregnancy.
CONCLUSIONS: Hormone therapy has varied response rates among women with endometrial hyperplasia or cancer who do not undergo surgery. Close patient monitoring remains paramount given the high recurrence and high percentage of patients who will not respond.
LEVEL OF EVIDENCE: II
Varied rates of disease response are observed in women treated for endometrial hyperplasia or early-stage cancer receiving oral progesterone or levonorgestrel-releasing intrauterine system hormone therapy.
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Supported by grant number T35-DK007386 (J.L.H.) from the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health.
Financial Disclosure The authors did not report any potential conflicts of interest.
The authors thank Susan Broisoisse, Kelly Felton, and Genevieve Ambrose for data acquisition.
Presented in part at the 57th Annual Meeting of the American College of Obstetricians and Gynecologists Annual Clinical Meeting, May 2–6, 2009; Chicago, Illinois.
Corresponding author: Paola A. Gehrig, MD, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7572; e-mail: Paola_Gehrig@med.unc.edu.