Treatment of advanced or recurrent cervical cancer by a new BOMP regimen consisting of bleomycin, vincristine, mitomycin-C, and low-dose consecutive cisplatin]

Twenty-five patients with cervical cancer (4 post-operative cases with FIGO stage Ib or IIb, 2 with stage IV, and 19 recurrence) were treated with a new BOMP consisting of bleomycin (5 mg/body, drip, i.v., days 1-7), vincristine (0.7 mg/m2, bolus, i.v., day 7), mitomycin-5 (7 mg/m2, bolus, i.v., day 7) and cisplatin (10 mg/m2, drip, i.v., days 1-7). The mean age of the patients was 54 years (range 30-77). Prior therapy included radiotherapy (13 cases), radical hysterectomy (11), and none (1). Fifteen (79%) of the 19 evaluable patients responded, including 6 with a complete response (CR) lasting over 15 months. Almost all the disease located in lung, liver, bone, and vulva showed a response. In particular, lesions confined to the lung had a 100% CR when the size of each tumor was under 2 cm in diameter even in the case of multiple metastasis. In contrast, 9 patients with pelvic disease had a 56% response with only 1 CR who had no previous radiotherapy. Such a poor response in the pelvic disease was considered to be due to vascularity reduced by prior radiotherapy. The important factors affecting the response to a new BOMP were found to be lesion size, prior radiotherapy, and the site of lesion. Patient age, performance status (PS), and the interval from a previous treatment to BOMP were not of significance with regard to response. The dose limiting factor was hematologic toxicities. Other toxicities including nausea, renal dysfunction, pulmonary fibrosis, and loss of hair were acceptable. Thus, the decrease in the PS of patients due to BOMP was minimal. It is suggested that this regimen will be useful as a neoadjuvant chemotherapy for advanced cervical cancer.     

Effective chemotherapy consisting of bleomycin, vincristine, mitomycin C, and cisplatin (BOMP) for a patient with inoperable vulvar cancer

Combination chemotherapy consisting of bleomycin, vincristine, mitomycin C, and cisplatin (BOMP) was first applied to an inoperable case (57-year-old) with FIGO stage IV (T3N3 + M1B) squamous cell carcinoma of the vulva. After three courses of BOMP therapy, the patient achieved a complete response with few toxic effects and subsequently could undergo radical vulvectomy with bilateral inguinal and pelvic lymphadenectomy. On microscopic examination, only a minute focus of viable squamous cell carcinoma was observed in the vulvar lesion and regional lymph nodes, which was surrounded by fibrotic or necrotic tissues. The patient received a further two courses of BOMP as postoperative chemotherapy. Five courses of BOMP were extremely tolerable and did not require special care. She has been free of disease for 20 months and her present performance status is 0. The encouraging result warrants the use of this combination chemotherapy regimen in other patients with advanced squamous cell carcinoma of the vulva.     

Outcome, complications and follow-up in surgically treated squamous cell carcinoma of the vulva 1956-1982.

Between 1956 and 1982, 139 patients were surgically treated in the Netherlands Cancer Institute because of a squamous cell carcinoma of the vulva. Eighty-nine of these patients underwent radical vulvectomy and inguinal lymph-node dissection. Five-year survival rates were 91% for stage I, 85% for stage II, 64% for stage III and 33% in stage IV cases. The fact that 5 year survival rates between the group of patients with a more extensive surgical treatment (i.e., inguinal lymph node dissection) and the group of patients only being treated by a vulvar operation were equal, is a remarkable result. Postoperative complication rates were, in conformity with results found elsewhere, high. Only 25% of the patients did not have any early complication at all. The most important early complication was found to be wound infection (52%). Late complications were mostly miction problems (24%) and pelvic relaxation, resulting in cystocele, rectocele and/or descensus uteri (26%). Patients who were treated only by a vulvar operation had significantly less late complications (P = 0.027). The majority of recurrences were observed in the first 2 postoperative years. Patients with a pelvic relapse or with distant metastases could in no case be treated successfully. Inguinal relapses, however, could only be treated with success when primary treatment of the groin had not been given before. Complete remissions were very often accomplished in case of vulvar relapse and second, third, or fourth relapses on the vulva. Ten percent of all the patients still alive 5 years after primary treatment had a relapse as yet, or more likely, a second vulvar carcinoma.(ABSTRACT TRUNCATED AT 250 WORDS)     

Medroxyprogesterone acetate therapy for patients with adenocarcinoma of the endometrium who wish to preserve the uterus-usefulness and limitations

BACKGROUND: To determine the effectiveness of medroxyprogesterone acetate therapy for women with endometrial adenocarcinoma who wish to preserve their uterus. STUDY DESIGN: Fifteen patients with endometrial carcinoma (12 with grade 1 endometrioid adenocarcinoma. 2 with grade 2 adenocarcinoma and 1 with adenoacanthoma) were treated with high-dose medroxyprogesterone acetate alone as primary therapy and their clinical responses evaluated. RESULTS: Seven of the 12 cases (58%) with grade I adenocarcinoma and one of the two (50%) with grade 2 carcinoma responded initially to medroxyprogesterone acetate. The median length of treatment required for regression was 29 weeks. Three patients who initially responded relapsed. Thirteen patients are alive without evidence of disease as of December 1999 (10 to 146 months, median; 4 years and 11 months) and one is continuing medroxyprogesterone acetate therapy as a final follow-up. One patient was lost to follow-up. Two patients have conceived having three healthy infants. CONCLUSION: Treatment of endometrial carcinoma with high-dose medroxyprogesterone acetate could be an alternative to hysterectomy, although the successful rate is limited.     

The role of prophylactic subtotal colectomy in metachronous carcinoma of the colon and rectum.

The risk of metachronous carcinoma of the colon and rectum at 40 year follow-up evaluation is as high as 30 percent. Because of this risk, we reviewed a series of 767 patients treated surgically for carcinoma of the colon and rectum to define a possible prophylactic role for subtotal colectomy. Patients being treated for metachronous carcinoma of the colon and rectum represented 1.6 percent of all patients undergoing surgical treatment for carcinoma of the colon and rectum during this period. There was an early group (less than 2.5 years) and a late group (greater than eight years); with respect to time interval between lesions, the early group possibly representing missed synchronous lesions. Forty-six percent of the patients had associated adenomas. Evaluation of the colon with preoperative colonoscopy may eliminate the "early" metachronous lesions that are probably missed synchronous lesions. The presence of adenomas in a younger patient with a primary carcinoma of the colon and rectum represents a high risk of future carcinoma. Subtotal colectomy should be considered in these patients and may also improve the life-long follow-up evaluation required by allowing proctosigmoidoscopy alone to evaluate effectively the remaining colon and rectum.     

Treatment of advanced cervical cancer by a combination of peplomycin, vincristine, mitomycin-C, and cisplatin

Eighteen patients with advanced or recurrent carcinoma of the cervix were treated with a combination of peplomycin, vincristine, mitomycin-C, and cisplatin (POMP). Ten of the 16 evaluable patients (63%) responded, including 4 with a complete response. Median duration of the response was 7 months. Two of 6 with intrapelvic recurrent tumors responded to some extent following intraarterial infusion. The subcutaneous infusion of peplomycin was well accepted by the patients. Toxicity was tolerable. This regimen seemed to be one of the regimens which should be considered for the advanced or recurrent cervical cancer.     

Evaluation of morbidity after external radiotherapy and intracavitary brachytherapy in 771 patients with carcinoma of the uterine cervix or endometrium

PURPOSE: The aim of the present study was to evaluate early and late radiation morbidity and to assess the factors influencing morbidity in patients with cervical or endometrial cancer treated by a combination of external radiotherapy (ERT) and intracavitary brachytherapy (IBRT). MATERIALS AND METHODS: Early and late radiation morbidity were evaluated retrospectively using RTOG/EORTC criteria and Franco-Italian glossary in 771 patients treated between November 1992 and December 1999. RESULTS: Four hundred and seven patients (52.8%) had endometrial carcinoma and 364 (47.2%) had carcinoma of the cervix. One hundred and fifty-four patients with cervical carcinoma were inoperable. In patients with endometrial carcinoma total doses at the vagina, bladder and rectum were 60.36 Gy, 56.2 Gy and 55.6 Gy respectively. Biologically equivalent doses (BED) for the same points were 79.35, 68.63 and 67.37, respectively for early effects and 123.67, 97.65 and 94.85, respectively for late effects. One hundred and sixty-nine patients (41.5%) developed acute morbidity, grade I and II bladder morbidity being the most common type and 85 patients (20.9%) developed late morbidity, grade I and II vaginal morbidity being the most common type. No grade IV morbidity was recorded. Total doses at the vagina, bladder and rectum in operated cervix cancer patients were 60.51 Gy, 56.53 Gy and 55.67 Gy, respectively. BED for the same points were 79.77, 69.36 and 67.52, respectively for early effects and 124.74, 99.3 and 95.17, respectively for late effects. Eighty patients (38.1%) developed early morbidity. Grade I and II bladder morbidity was the most common type. Sixty-five patients (30.9%) developed late morbidity, vaginal morbidity being the most common type. Total doses at the vagina, bladder and rectum in inoperable patients were 70.92 Gy, 66.71 Gy and 62.38 Gy, respectively. BED for the same points were 97.43, 89.64 and 81.63, respectively for early effects and 159.3, 143.16 and 126.56, respectively for late effects. Sixty patients (39%) developed acute morbidity which was grade I or II bladder morbidity in 95%. Ninety-five patients (61.7%) developed late morbidity which was grade I-III vaginal morbidity in 94%. CONCLUSION: Patients with cervical or endometrial cancer can be treated safely by a combination of ERT and IBRT. However the patients should be assessed before, during and after treatment and at every period of follow-up using a standard and well-defined system in order to define and predict the morbidity rate.     

Surgical treatment of invasive carcinoma of the vulva. Our experience

OBJECTIVE: The purpose of this study was to investigate the clinical findings, treatment and outcome of patients with vulvar carcinoma in the L'Aquila area. METHODS: Fifteen cases of vulvar carcinoma seen between September 1991 and December 1999 at the Department of Obstetrics and Gynecology of the University of L'Aquila were reviewed. Clinical, pathologic, surgical and follow-up data were collected from patient records. Mean age at diagnosis was 66.4 years. All patients were evaluated through a careful medical history and physical examination, vulvoscopy, abdomino-pelvic CT or MR, urethrocystoscopy, rectocolonscopy and SCC, and CEA determination. Radical surgery included six patients treated by the Taussig-Way operation. Modified radical surgery accounted for nine patients treated by the Byron three-incision approach. RESULTS: The major early complication was groin wound breakdown which occurred in four cases. The major late complication was chronic leg edema which was reported in six patients. The average number of nodes removed per patient was 19.5. Seven patients (46.7%) had a T2N0M0 pathologic stage, four (26.7%) were T2N1M0, four (26.7%) T1N0M0. Five patients died of local and distant recurrences within 37 months after surgical treatment; ten patients are alive, nine are apparently free from disease whereas one presented local and systemic recurrence within 18 months after surgery. CONCLUSIONS: Vulvar carcinoma predominantly affects older women. Most patients in our series (11/15) had tumors more than 2 cm in diameter. Although the vulva is an external organ and early detection should be achieved, many patients presented with extensive primary lesions due to both patient and physician delay. Stage of disease, tumor size, and nodal metastases are potential prognostic factors useful in selecting patients for a more conservative surgical approach.     

Immunostimulation with intraperitoneally administered bacille Calmette Guérin for advanced malignant tumors of the gastrointestinal tract.

Thirty-five patients with advanced malignant tumors of the stomach, pancreas, biliary tract or colon were treated intraperitoneally with bacille Calmette Guérin and, subsequently, were given orally booster doses of bacille Calmette Guérin and one of two schedules of cytotoxic drugs. Patients with all types of tumors responded, but this was most marked in patients with metastases to the liver from primary carcinoma of the colon.     

Treatment of high-risk gestational trophoblastic disease with methotrexate, actinomycin D, and cyclophosphamide chemotherapy

Seventy-three patients with metastatic high-risk gestational trophoblastic disease were treated with methotrexate, actinomycin D, and cyclophosphamide chemotherapy at the Brewer Trophoblastic Disease Center between 1968 and 1982. Forty-six patients were treated primarily with methotrexate, actinomycin D, and cyclophosphamide because of the presence of one or more high-risk factors. Twenty-seven additional patients who had not responded to initial single-agent chemotherapy with methotrexate and/or actinomycin D were subsequently treated with methotrexate, actinomycin D, and cyclophosphamide. Adjuvant surgery and radiotherapy were used in selected patients. The overall cure rate was 51% (37 of 73): 63% (29 of 46) for primary treatment and 30% (eight of 27) for secondary treatment (P less than .01). Several factors that influenced response to primary treatment with methotrexate, actinomycin D, and cyclophosphamide chemotherapy were determined: 1) clinicopathologic diagnosis of choriocarcinoma versus invasive mole (59 versus 100%), 2) metastases to sites other than the lung and/or vagina (44 versus 74%), 3) antecedent term gestation compared with hydatidiform mole or abortion (50 versus 75%), and 4) presence of three or more high-risk factors (27 versus 74%). There were no significant differences in cure rates during the course of the study period.     

Primary treatment of Bartholin''s gland carcinoma with radiation and chemoradiation: a report on ten consecutive cases

We reviewed our experience with primary radiation therapy for Bartholin's gland carcinoma (BGC) as an alternative to traditional surgical treatment. A retrospective study reviewed records from the Cancer Data Registry and Research Patient Data Registry from 1986 to 2002. Charts of ten women identified with BGC were reviewed for demographic information, presenting symptoms, tumor characteristics, treatment modalities, and complications, as well as for recurrence and survival. The incidence of BGC was 2.13% of all invasive vulvar cancer cases at the Massachusetts General Hospital (MGH). Four patients presented with clinical stage I disease, one with stage II, three with stage III, and two with stage IV. The median age at diagnosis was 63.5 years. There were five squamous cell carcinomas, two adenoid cystic carcinomas, two mucinous adenocarcinomas, and one small-cell carcinoma. After a change in treatment policy in 1986 from primary surgery that had often required postoperative radiation therapy, ten consecutive patients were treated with primary radiotherapy or chemoradiation therapy. Treatment included teletherapy combined with a boost to the primary site, regional nodes and/or interstitial brachytherapy. Short-term complications were mild and well tolerated; one patient developed late radiation-associated pelvic fractures. Four tumors recurred with a mean time to recurrence of 31.2 months. The median follow-up was 87.2 months (45-142). Three- and 5-year survivals were 71.5% and 66%, comparable to outcomes after surgery and postoperative radiation therapy. We conclude that primary radiation or chemoradiation therapy offers an effective alternative to surgery in the treatment of BGC with preservation of genital function and low morbidity.     

A study of the treatment of ovarian carcinoma

Between 1970 and early 1980, 213 patients were treated for ovarian carcinoma (stages Ib-IV) at the Department of Obstetrics and Gynecology, Graz University Medical School. Until mid 1976 patients were given postoperative radiotherapy; after that they were given combination chemotherapy (adriamycin and cyclophosphamide) according to Lloyd or Parker [18, 20, 21]. An analysis of the results led to the following conclusions: The operability at primary surgery is of prime importance, the best survival rates (regardless of postoperative management) being obtained in those patients in whom it is possible to do a pelvic clearance (removal of uterus, tubes and ovaries) with omentectomy. In patients who were operable postoperative chemotherapy was markedly superior to radiotherapy in terms of 1 year survival. But only slightly superior at 2 and 5 years. On the other hand, in patients who had palliative surgery postoperative radiotherapy seemed to give slightly better survival figures. Patients with early carcinoma (up to stage IIa) survived longer than those with late stages of carcinoma (IIb-IV) whether operable or not). The histology of the tumour had no discernible influence on the result both of chemotherapy and of radiotherapy. The patients with endometrioid and mucinous carcinomas had the highest survival rates irrespective of the postoperative treatment. However, the patients with serous cystadenocarcinomas survived longer than those with immature solid carcinomas. Patients who had no tumour at a second-look operation lived longer than those who had tumour at this time. Patients whose tumour recurred after the completion of postoperative radiotherapy and who were then given chemotherapy had the highest survival rates regardless of whether nor not the carcinoma was originally operable. It is felt that radiotherapy followed by chemotherapy should be used routinely especially in patients with late stages of ovarian carcinoma.     

Squamous cell carcinoma antigen and carcinoembryonic antigen levels as prognostic factors for the response of cervical carcinoma to chemotherapy

Between January 1986 and December 1988, 36 patients with primary advanced or recurrent cervical carcinoma were treated with cytostatic drugs in our department. Treatment at first was a combination of cisplatin and etoposide. After August 1987, a combination of carboplatin and ifosfamide was used. In all patients showing primary response to therapy, the squamous cell carcinoma antigen (SCC) and carcinoembryonic antigen (CEA) levels fell rapidly to normal after one or two cycles. In contrast, clinical remission was not obtained in those patients with levels which remained high or rose again following an initial decrease. Chemotherapy is often the only available therapy for advanced cervical carcinoma or recurrent disease, although the results of treatment, especially in squamous cell carcinoma, remain poor. The course of the SCC or CEA levels can help to decide whether the patient would profit from a continuation of the therapy. With the tumor markers, treatment can be individualized so that, above all, cases of therapy failure or further tumor progression can be detected early and the patient can be spared the severe side effects of the treatment.     

13例子宫内膜癌合并多原发恶性肿瘤临床分析

目的 提高对子宫内膜癌合并多原发性恶性肿瘤认识;方法 采用回顾性分析方法。对1982年7月-1999年8月我院共收治201例子宫内膜癌患者中合并多原发性恶性肿瘤患者的临床资料及治疗结果进行分析;结果13/201例子宫内膜癌合并多原发性恶性肿瘤(6％),其中同时性多原发恶性肿瘤6例(2.98％),平均发病年龄51.4岁,发生部位在卵巢、结肠及乳腺;异时性多原发恶性肿瘤7例(3.5％),第一恶性肿瘤年龄46.4岁,子宫内膜癌发病年龄54.5岁,发生部位乳腺、肾脏、卵巢、脑及结肠。治疗均以手术为主的综合治疗;结论 重视子宫内膜癌合并多原发性恶性肿瘤,高危患者定期复查,早发现,早治疗。     

Carcinoma of the cervix, FIGO Stage IB: treatment failures

All patients with carcinoma of the cervix, FIGO Stage IB, treated at the University of Minnesota Hospitals during a 10-year period were reviewed. Of the 220 patients 31 (14.0%) developed recurrent disease and did not survive. Thirteen patients had pelvic wall recurrences, with concurrent cervical involvement. No patient had a resectable pelvic recurrence. Hysterectomy was subsequently performed on 10 of the 172 patients who received radiation therapy. Carcinoma was not present in any of the operative specimens although two patients with adenocarcinoma later died of metastatic cancer. Median time of recurrence was 9 months, with median survival following recurrence of 6 months. Cervical cytology was not of value in the early diagnosis of recurrent disease. The 5-year adjusted actuarial survival rate for patients with adenosquamous carcinoma was significantly lower than that for patients with squamous cell carcinoma. The median age of patients not surviving with adenosquamous carcinoma was significantly lower than that for patients not surviving with squamous cell carcinoma. Patients with invasive carcinoma presumably confined to the cervix may have disseminated disease. It is essential such selected patients receive primary treatment that includes systemic therapy.     

Angiosarcoma de mama

ObjectiveTo report the cases of non-metastatic angiosarcoma of the breast treated in our hospital and review the literature.MethodsWe performed a retrospective analysis of the cases of angiosarcoma of the breast treated in our hospital.ResultsFour cases where identified, all occurring in women. There were 3 cases of primary angiosarcoma, and 1 case of radiotherapy-induced angiosarcoma after conservative treatment for infiltrating ductal carcinoma of breast. Among the patients with primary angiosarcoma, 1 patient was treated with wide local resection, and 2 patients underwent mastectomy. One patient received subsequent chemotherapy and another patient received radiotherapy. The 3 patients presented early recurrence, with a mean interval of 8 months, and were treated with rescue surgery. Only one patient survived and has no evidence of recurrent disease after 8 months, while the remaining 2 patients died at 28 and 41 months after the initial intervention. In 1 patient, radiotherapy-induced angiosarcoma developed 6 years after surgery for ductal carcinoma. Mastectomy was performed. The patient developed recurrence 3 years later and underwent surgery with curative intent but died 9 months after the second intervention.ConclusionsAngiosarcoma of the breast is a rare and often misdiagnosed disease with a poor prognosis. The treatment is early complete surgical excision of the mass with adequate margins. Many authors recommend mastectomy. Local recurrence is frequent and indicates poor prognosis, although it does not rule out a further intervention, even with curative intent. The role of adjuvant therapy remains unclear.     

Neuroendocrine tumors of the uterine cervix. Clinicopathologic study of five patients

Four main clinicopathologic features of neuroendocrine tumors (NETs) of the cervix may be stressed: primary diagnosis at an advanced stage, early nodal metastasis even for low disease, early failure of appropriate local treatment (surgery and/or radiation therapy) and aggressive clinical treatment. Five patients with NET of the uterine cervix (small cell carcinoma type) are reported (one stage I, two stages II, one stage III and one stage IV). One patient was treated by surgery combined with radiation therapy, one by surgery combined with chemotherapy and one by surgery with radiation therapy and chemotherapy. Two patients received radiation therapy alone. Three early stage patients are alive with no evidence of disease 8, 26 and 41 months after diagnosis. The two patients with advanced stage died of disease, 3 and 12 months respectively, after diagnosis. Combination chemotherapy (cisplatin and etoposide) is warranted in disseminated NETs. Neoadjuvant or adjuvant chemotherapy should be combined with radiation therapy and surgery even in early stages.     

Ureteral assessment after radical hysterectomy

Postoperative intravenous pyelography was performed in 233 patients with stage IB cervical carcinoma treated with radical hysterectomy and pelvic lymphadenectomy between January 1962 and December 1985. Four patients developed symptoms of ureteral injury, two (0.8%) ureteral fistulae, and one (0.4%) stricture and obstruction due to recurrent carcinoma. No ureteral injuries were observed in 229 asymptomatic patients. A 5.2% incidence of transient severe ureteral dilatation occurred in asymptomatic patients, but resolved within a median of 94 days. A significant urinary tract anomaly was observed in 3.4% of preoperative pyelograms. All of these anomalies were apparent at surgery and presented no intraoperative difficulties. Three patients (1.3%) sustained intraoperative ureteral transections, which were diagnosed and repaired without sequelae. In patients with early cervical carcinoma having primary operative treatment, the role of routine preoperative and postoperative intravenous pyelography is questionable.     

小于35岁子宫颈癌患者213例治疗与预后分析

目的分析小于35岁妇女宫颈癌的临床表现、诊断和治疗的特点。方法回顾分析1986年1月至2006年7月收治的年轻妇女宫颈癌213例的临床资料。结果年轻妇女宫颈癌占全部宫颈癌的比例呈逐年上升的趋势;其临床表现主要为接触性阴道出血(59.62%)。0期、Ⅰ期、Ⅱ期、Ⅲ期、Ⅳ期患者的5年生存率分别为100%、79.51%、43.25%、31.71%、0。13例宫颈原位癌行宫颈锥切术,1例宫颈原位癌行LEEP术,术后均无肿瘤复发。27例宫颈癌在广泛性子宫切除手术同时行卵巢移位术,术后无1例卵巢发生癌转移。21例(12例Ⅰb2期,9例Ⅱb早期)经术前介入化疗(新辅助化疗)后行广泛性子宫切除及盆腔淋巴结清扫术,5年生存率为76.25%。5例术前放疗后行广泛性子宫切除及盆腔淋巴结清扫术,5年生存率为60.00%。两者无统计学差异(P>0.05)。结论应对筛查年轻妇女宫颈癌予以重视,对有接触性阴道出血的年轻妇女应予高度警惕。治疗年轻妇女宫颈癌时应注意保留早期患者的生育功能、卵巢功能及性功能,对局部晚期患者可用术前新辅助化疗,以提高手术切除率,改善患者的生活质量。     

高分化子宫内膜样癌及子宫内膜重度不典型增生患者孕激素治疗的临床分析

目的探讨35岁以下高分化子宫内膜样癌及子宫内膜重度不典型增生患者采用孕激素治疗以保留患者子宫的疗效,并随访其治疗后的生育情况.方法采用回顾性分析的方法对1991年至2005年北京协和医院收治的35岁以下、接受孕激素治疗（以醋酸甲羟孕酮为主）的25例高分化子宫内膜样癌及子宫内膜重度不典型增生患者的临床病理资料进行研究.其中,子宫内膜样癌8例（内膜癌组）,子宫内膜重度不典型增生17例（不典型增生组）.孕激素治疗前对患者进行全面的分期评估,治疗后每1～6个月诊刮以评价疗效,对有生育要求者随访其生育情况.结果内膜癌组患者孕激素治疗前经全面的分期评估,证实为早期、高分化子宫内膜样癌.除1例子宫内膜样癌患者尚未评估疗效外,内膜癌组其他7例及不典型增生组17例患者治疗后有效者分别为6例（6/7）、17例（100%）;缓解者分别为5例（5/7）、14例（82%）;缓解后复发者分别为1例（1/5）、3例（21%）,复发时间为缓解后6～30个月;随访缓解后要求生育的14例患者中,内膜癌组4例患者尚未生育,不典型增生组10例患者中4例妊娠共7次.1例自然受孕后失访;3例经促排卵治疗后受孕并足月分娩,其中1例产后人工流产3次.结论对于要求保留子宫的高分化子宫内膜样癌及子宫内膜重度不典型增生的年轻患者,孕激素治疗是一种治疗选择.孕激素治疗前应对子宫内膜样癌患者进行详细全面的分期评估,辅助生殖措施的介入有望提高治疗后的妊娠率.