A 45-year-old premenopausal woman with Stage IA Grade 1 endometrial carcinoma (endometrioid type, myometrial invasion <50%) wants to preserve her uterus and fertility. Which of the following regimens is currently recommended for fertility-sparing treatment of Grade 1 endometrioid endometrial cancer Stage IA?
- A Levonorgestrel IUS (Mirena) alone for 12 months
- B GnRH agonist therapy for 6 months followed by IVF
- C Hysteroscopic resection of the tumour followed by brachytherapy
- D High-dose oral progestin (megestrol acetate 160 mg/day or medroxyprogesterone acetate 500 mg/day) with periodic endometrial sampling ✓
Explanation
Fertility-sparing treatment of Grade 1 endometrioid endometrial carcinoma Stage IA (limited to endometrium, no myometrial invasion) uses high-dose continuous progestin therapy — most commonly megestrol acetate 160 mg/day or medroxyprogesterone acetate 500 mg/day orally, sometimes combined with the levonorgestrel IUS. Response rates are 45–80% and complete response requires repeat biopsy at 3–6 months. After completing childbearing, definitive hysterectomy is recommended. This approach is suitable only for Grade 1 endometrioid carcinoma with no myometrial invasion, no lymphovascular involvement, and disease not suitable for Grade 2/3 or non-endometrioid histology.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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