LAUSR

Study Objective to determine the oncologic and reproductive outcomes in women with endometrial hyperplasia with atypia (AH) or stage IA grade 1 endometrioid endometrial cancer (EEC) undergoing medical management with high-dose progestin therapy in our hospital. Design retrospective cohort study. Mean follow-up of patients of 46 months (range 4-156). Setting academic hospital, third level of clinical care. Patients or Participants 38 patients treated with progestin therapy, between 2004 and 2018. 31 had AH, and 7 had EEC. Conservative treatment was performed for fertility preservation (71.1% of patients), or due to patient's surgical risk (18.4%) or patient´s decision (10.5%). Interventions therapies included levonorgestrel intrauterine device (73.6%), megestrol acetate (13.2%), and medroxyprogesterone (13.2%). Measurements and Main Results the median age of patients was 41 (29-74). Patients were re-evaluated clinically every 3-6 months, and surveillance transvaginal ultrasound and/or hysteroscopy with endometrial sampling were performed at variable intervals. Complete response was evinced in 33 patients (86.8%). The mean time to remission was 6.7 months (3-18). Recurrence was observed in 4 women (10.5%) after discontinuing treatment to look for pregnancy, 2 of them with an initial diagnosis of AH, and the other 2 with EEC. 3 patients (7.9%) had progression from AH to EEC, and a hysterectomy with salpingo-oophorectomy was performed. Persistence disease was noted in 2 cases (5.3%), both of them with an initial diagnosis of EEC. 25 out of 28 (89.3%) patients treated with a levonorgestrel intrauterine device experienced remission of disease. Among the patients in the fertility preservation group, 23 (85.2%) had remission, of whom 11 looked for pregnancy and 4 got pregnant. Overall survival was not affected. Conclusion according to our experience, conservative treatment can be considered for AH and stage IA grade 1 EEC, with close and minimally invasive surveillance