Prospective study of fertility-sparing treatment with Chlormadinone
acetate for endometrial carcinoma and atypical hyperplasia in young
Objective In women with endometrial hyperplasia or stage 1A
cancer, fertility-sparing treatment using progestin therapy is known to
be safe and effective. International recommendations advise the use of
megestrol acetate or medroxyprogesterone acetate. However, chlormadinone
acetate has fewer adverse effects and can be used in patients at high
vascular risk. In the present prospective study, we aimed to confirm
that the efficiency of 6 months chlormadinone acetate administration to
obtain remission of atypical hyperplasia or stage 1A endometrial
carcinoma is comparable to that of the use of other fertility-sparing
treatments. Design A prospective, observational study.
Setting Nationwide France PREFERE prospective registry.
Population Women with endometrial hyperplasia or stage 1A
cancer willing to preserve their fertility Methods All patients
received three or six months of chlormadinone acetate and were evaluated
by hysteroscopic resection and pipelle sampling every three months.
Main outcome measure Complete remission rate. Results
Ninety-four patients were included. Seventy-nine patients achieved
complete remission at 6 months (84%). No patients stopped treatment due
to a lack of tolerance. Twenty-four percent of the patients achieved a
live birth during a twenty-eight months follow up. Conclusion
Chlormadinone acetate is an effective and well-tolerated
fertility-sparing treatment. Its benefits over other progestins is its
tolerability, and its absence of contraindications which makes
chlormadinone acetate a good choice for patients with thromboembolism
and high vascular risk.