109 GnRH agonist plus medroxyprogesterone acetate for fertility-sparing treatment of stage IA-G1 endometrial cancer and atypical endometrial hyperplasia

Introduction/Background Hormone therapy with progestin is thought to be a challenging option for a subgroup of women who have the atypical endometrial hyperplasia (AEH) and carcinoma (grade I with no myometrial invasion, ECC). While there are guidelines on the management, no comparative study exists on regarding the optimal type and dose of progestin and follow-up schedule. We assessed outcomes for patients consecutively treated with GnRH agonist and oral progestin. Methodology Patients with AEH or ECC who were treated with GnRH agonist (Goserelin depot 3.6mg) and oral medroxyprogesterone acetate (MPA, 500mg) were included from January 2021 to January 2023 in the obstetrics and gynecology Gachon university Gil medical center, Incheon, Korea. Women who were eligible patients met the following criteria: age between 15 and 40 years, histological diagnosis of AEH or ECC (endometrioid, grade I, without myometrial invasion), no evidence of extrauterine metastasis by enhanced magnetic resonance imaging (MRI), enhanced computed tomography (CT), no contraindication for GnRH agonist or medroxyprogesterone acetate, desire to pregnancy. The efficacy of treatment was evaluated by hysteroscopically guided biopsy every 3 months. Results Sixteen patients were included in this study, with age of 32.5 years (mean, range 23 – 40), body mass index of 31.03 kg/m2 (mean, range 24.1 – 39.3), pretreatment CA 125 of 10.1 (mean, range 4.6 – 20.5). Complete response rate was 100%. Time to complete response was 3- 15 months. After complete response 11 patients were treated with LNG-IUD and 5 patients have tried to conceive (table 1). Conclusion The combination of GnRH agonist and MPA suggested promising response in AEH or ECC patients who wished to preserve their fertility. Disclosures There are no financial conflicts of interest to disclose.