Eficácia e segurança do acetato de megestrol para o tratamento da anorexia nos cuidados paliativos: revisão rápida de evidências / Efficacy of the megestrol acetate in the treatment of anorexia in palliative care: a rapid response review of evidence

Acetato de Megestrol (AM). Indicação: Tratamento da Síndrome anorexia-caquexia (SAC) em doentes crônicos em fase de cuidados paliativos. Objetivo: Avaliar a eficácia e segurança do uso do AM em doentes crônicos sob cuidados paliativos. Métodos: Foi realizada uma revisão rápida de revisões sistemáticas, com levantamento bibliográfico nas bases de dados PUBMED, EMBASE, SCOPUS, BVS, Cochrane Library, Web Of Science e em registros de revisões sistemáticas e ensaios clínicos. A qualidade metodológica dos estudos incluídos foi avaliada com a ferramenta AMSTAR-2 (Assessing the Methodological Quality of Systematic Reviews Version 2). Resultados: A busca recuperou um total de 2.370 após exclusão das duplicatas; 1003 estudos foram triados pelo título e resumo, de acordo com os critérios de inclusão previamente estabelecidos. Dezesseis RSs foram selecionadas para leitura completa, sendo que, destas, apenas 1 RS foi classificado com alta qualidade metodológica. Após a análise dos ECR das RSs excluídas, um ECR foi incluído considerando os critérios de inclusão. Dois estudos adicionais publicados posteriormente a RS de Ruiz-Garcia et al. Conclusão: Com base nas evidências disponíveis, o AM proporciona leve ganho de peso e melhora o apetite, porém esses resultados não refletem melhoria na qualidade de vida dos pacientes, além de haver risco considerável de desenvolver fenômenos tromboembólicos

Megestrol acetate (MA). Indication: treatment of anorexia-cachexia syndrome (ACS) in chronic diseases patients, under palliative care. Objective: Evaluate the efficacy and safety of the use of Megestrol Acetate to treat ACS in patients under palliative care. Methods: Rapid review protocol of Systematic Reviews and Clinical Trials. A literature Search was performed in PUBMED, EMBASE, SCOPUS, BVS, Cochrane Library, Web of Science databases and in clinical trials records, following a predefined strategy. The methodological quality of the selected articles was assessed through AMSTAR-2 (Assessing the Methodological Quality of Systematic Reviews Version 2) tool. Results: the search resulted in 2,370 articles, after the duplicates exclusion. 1003 were analyzed by tittle and abstracts according the inclusion criteria. 16 were selected for full text reading, and only one considered to have high methodological quality. After the analyses of the Randomized Clinical Trials of the excluded Systematic Reviews, one RCT was included. Two additional studies published after the SR of Ruiz-Garcia et al were also included. Conclusion: based on available evidence, the MA promoted a small gain in body weight and a slight appetite improvement, although these results did not imply an enhancement in their quality of life. Moreover, there is a considerable risk of causing thromboembolic disorders

Study on the Marker Steroids of New Zealand Deer (Cervus elaphus var. scoticus) Velvet Antler by UPLC-MS/MS and HPLC-PDA Methods

Eleven steroid hormones (SHs: androstene-3,17-dione, estrone, β-estradiol, α-estradiol, testosterone, dehydroepiandrosterone, 17á-hydroxyprogesterone, medroxyprogesterone, megestrol acetate, progesterone, and androsterone) were detected from New Zealand deer (Cervus elaphus var. scoticus) velvet antler (NZA, 鹿茸). A method for the quantification of eleven SHs was established by using ultraperformance liquid chromatography (UPLC)-MS/MS. The linearities (R² > 0.991), limits of quantification (LOQ values, 0.3 ng/mL to 23.1 ng/mL), intraday and interday precisions (relative standard deviation: RSD 0.999), LOQ values (30 ng/mL to 350 ng/mL), intraday and interday precisions (RSD < 1.93%), and recovery rates (97.2% to 103.5%) for the three 7-O-CSs were determined. These quantitative methods are accurate, precise, and reproducible. As a result, it is suggested that the five steroid compounds of androstene-3,17-dione, androsterone, 7-ketocholesterol, 7α-hydroxycholesterol, and 7β-hydroxycholesterol could be marker steroids of NZA. These methods can be applied to quantify or standardize the marker steroids present in NZA.

Fertility preserving treatment with hysteroscopic resection followed by progestin therapy in young women with early endometrial cancer / 부인종양

OBJECTIVE: To report our 15-year institutional experience of fertility-sparing treatment in young patients with early endometrial cancer (EC) treated by combined hysteroscopic resection and progestin therapy. METHODS: Twenty-eight patients (stage IA, G1 and 2 endometrioid EC) wishing to preserve their fertility were enrolled into this prospective study. Hysteroscopic resection was used to resect the tumor, endometrium adjacent to the tumor and myometrium underlying the tumor. Adjuvant hormonal therapy consisted of oral megestrol acetate or levonorgestrel intrauterine device for 6 months or more. RESULTS: After 3 months from the progestin start date, 25 patients (89.3%) showed a complete regression (median time to complete regression, 3 months [range, 3-9 months]), two (7.1%) showed persistent disease, while one patient (3.6%) presented with progressive disease and underwent definitive surgery (stage IA, G3 endometrioid). At 6 months, one of the two patients with persistent disease underwent definitive surgery (stage IA, G1 endometrioid), while the other one was successfully re-treated. Two recurrences were observed (7.7%) both involving the endometrium and synchronous ovarian cancer. The median duration of complete response was 94.5 months (range, 8-175 months). More than half of the responders (57.7%) attempted to conceive with 93.3% and 86.6% pregnancy and live birth rates, respectively. CONCLUSION: The addition of a standardized three-step resectoscopy to progestin would seem to improve the efficacy of progestin alone. High pregnancy and live birth rates were observed in women attempting to conceive.

Appetite stimulants for older persons

Anorexia is one of the most common issues in older patients. Although there is a tendency for loss of appetite in older persons due to decreased physical activity and reduced resting metabolic rate, this physiological anorexia of aging can easily develop into progressive anorexia and weight loss. This pathologic anorexia and resultant weight loss is associated with increased morbidity and mortality, especially in the frail elderly. To prevent older persons from entering a vicious cycle of frailty, that is, anorexia-malnutrition-sarcopenia-functional impairment, routine screening for anorexia and malnutrition should be implemented in geriatric clinical practice. All anorexic elderly patients should be strongly encouraged to maintain their nutrition, and appetite stimulants can be considered if non-pharmacological interventions are not effective. Although there are no US or Korea Food and Drug Administration approved medications for geriatric-specific anorexia and weight loss, several appetite stimulants can be prescribed and are used widely. Megestrol acetate is the most widely studied and commonly used of these drugs. Cyproheptadine, dronabinol, mirtazapine, corticosteroids, anabolic steroids (e.g., testosterone or oxandrolone), and growth hormone are also effective in increasing appetite or weight. However, the use of these orexigenic agents should occur only after their benefit-to-risk ratio has been carefully considered.

Atividade de acetato de magestrol em mulheres na pós-menopausa com câncer de mama avançado pós progressão de inibidor de aromatase: estudo de fase II / Activity of megestrol acetate in postmenopausal women with advancedbreast cancer after non-steroidal aromatase inhibitor failure: a phase II trial

Introdução: Novos tratamentos são dispendiosos e muitas vezes tem custo proibitivo em países de baixa e média renda. Dessa forma, há uma necessidade urgente de desenvolvimento de alternativas, tais como a avaliação de fármacos que perderam sua patente. Acetato de megestrol (AM) tem uma longa história no tratamento do câncer de mama, mas recentemente tem sido menos utilizado devido ao advento de novos agentes. Esse estudo de fase II avaliou a atividade antitumoral e a toxicidade de AM em mulheres na pós-menopausa com câncer de mama avançado hormônio-sensível, após progressão de doença durante terapia com inibidor de aromatase (IA) não esteroidal de terceira-geração. Pacientes e métodos: Pacientes elegíveis tinham câncer de mama metastático tratado com IA por um período mínimo de 6 meses desobrevida livre de progressão durante o tratamento da doença avançada, ourecorrência após um ano ou mais em caso de tratamento adjuvante. As pacientes receberam AM como dose oral única de 160 mg diária. O objetivo principal era benefício clínico. Resultados: Quarenta e oito pacientes foram incluídas. O benefício clínico foi de 40% (IC 95% 25%-55%). A sobrevida livre de progressão foi de 3,9 (IC 95% 3.0–4.8) meses e a duração mediana do benefício clínico de 10 (IC 95% 8.0–14.2) meses. Efeitos colaterais grau 3 foram: anemia (2%), dispneia (2%), fadiga (2%), dor músculo-esquelética (4%), trombose venosa profunda (10%) e ganho depeso (2%). Conclusões: Esse é o primeiro estudo a avaliar de forma prospectiva a eficácia e a segurança de AM em mulheres na pós-menopausa com câncer de mama avançado com doença hormônio-sensível após progressão de IA. AM demonstrouatividade e boa tolerabilidade nesse cenário e assim permanece como uma opção a ser considerada em situação de limitação de recursos. Esses resultados também justificam a continuidade da exploração de novos progestágenos no tratamento do câncer de mama

Background: As novel treatments carry substantial price tags and are mostly costprohibitive in low- and middle-income countries, there is an urgent need to develop alternatives, such as off-patent drugs. Megestrol acetate (MA) has a longstanding history in the treatment of breast cancer, but recently it is being used less often due tothe advent of newer agents. Patients and methods: This two-stage phase II trial evaluated the antitumor activity and toxicity of MA in postmenopausal women with hormone-sensitive advanced breast cancer who had experienced disease progressionon a third generation nonsteroidal aromatase inhibitor (NSAI). Eligible patients had metastatic breast cancer treated with a NSAI with at least 6-month progression-free survival (PFS), or relapse after ≥1 year on adjuvant NSAI. Patients received MA at asingle daily oral dose of 160 mg. Primary end point was clinical benefit rate (CBR). Results: Forty-eight patients were enrolled. The CBR was 40% [95% confidence interval (CI) 25% to 55%], and the median duration of clinical benefit was 10.0 (95%CI 8.0–14.2) months. The median PFS was 3.9 (95% CI 3.0–4.8) months. The most common grade 3 adverse events were anemia (2%), dyspnea (2%), fatigue (2%), musculoskeletal pain (4%), deep vein thrombosis (10%), and weight gain (2%). Conclusions: This is the first study to prospectively evaluate the efficacy and safetyof MA in postmenopausal women with hormone-sensitive disease progressing on a NSAI. MA has demonstrated activity and acceptable tolerability in this setting, and therefore remains a reasonable treatment option in a cost-sensitive environment. These results also provide the background for further evaluation of progestins in the treatment of breast cancer

Conservative treatment for atypical endometrial hyperplasia: what is the most effective therapeutic method? / 부인종양

No abstract available.

Conservative therapy with metformin plus megestrol acetate for endometrial atypical hyperplasia / 부인종양

OBJECTIVE: To compare the efficacy of metformin plus megestrol acetate (MA) with that of MA alone for treating endometrial atypical hyperplasia (EAH). METHODS: This pilot study included 16 EAH patients who met at least one metabolic syndrome (MS) criterion and received either adjunctive metformin plus MA (MET group) or MA monotherapy (MA group). Each patient in the MA group received 160 mg of MA daily, whereas patients in the MET group received the same dose of MA plus 0.5 g of metformin thrice daily. Treatment response was assessed by histological examination of dilation and curettage specimens obtained after 12 weeks of therapy. RESULTS: Each group had eight patients, and half of the patients in each group were diagnosed with MS. The complete response (CR) rate was 75% (6/8) in the MET group and 25% (2/8) in the MA group (p=0.105). Complications of MS did not affect the response rates in either group. In the MET group, 75% (3/4) of the patients had CR in the presence or absence of MS. In the MA group, 50% (2/4) of the patients with MS had CR, whereas no patient without MS had CR. No irreversible toxicities were observed. CONCLUSION: Metformin plus MA may be a potential alternative therapy for treating EAH, and the MS status of patients may have no effect on the efficacy of metformin plus MA therapy.

Atividade de acetato de megestrol em mulheres na pós- menopausa com câncer de mama avançado após progressão de inibidor de aromatase: estudo de fase II / [Megestrol acetate activity in postpartum women menopause with advanced breast cancer after progression of aromatase inhibitor: phase II study]

Introdução: Novos tratamentos são dispendiosos e muitas vezes tem custo proibitivo em países de baixa e média renda. Dessa forma, há uma necessidade urgente de desenvolvimento de alternativas, tais como a avaliação de fármacos que perderam sua patente. Acetato de megestrol (AM) tem uma longa história no tratamento do câncer de mama, mas recentemente tem sido menos utilizado devido ao advento de novos agentes. Esse estudo de fase II avaliou a atividade antitumoral e a toxicidade de AM em mulheres na pós-menopausa com câncer de mama avançado hormônio-sensível, após progressão de doença durante terapia com inibidor de aromatase (IA) nãoesteroidal de terceira-geração. Pacientes e métodos: Pacientes elegíveis tinham câncer de mama metastático tratado com IA por um período mínimo de 6 meses de sobrevida livre de progressão durante o tratamento da doença avançada, ou recorrência após um ano ou mais em caso de tratamento adjuvante. As pacientes receberam AM como dose oral única de 160 mg diária. O objetivo principal era benefício clínico. Resultados: Quarenta e oito pacientes foram incluídas. O benefício clínico foi de 40% (IC 95% 25%-55%). A sobrevida livre de progressão foi de 3,9 (IC 95% 3.0­4.8) meses e a duração mediana do benefício clínico de 10 (IC 95% 8.0­ 14.2) meses. Efeitos colaterais grau 3 foram: anemia (2%), dispneia (2%), fadiga (2%), dor músculo-esquelética (4%), trombose venosa profunda (10%) e ganho de peso (2%). Conclusões: Esse é o primeiro estudo a avaliar de forma prospectiva a eficácia e a segurança de AM em mulheres na pós-menopausa com câncer de mama avançado com doença hormônio-sensível após progressão de IA. AM demonstrou atividade e boa tolerabilidade nesse cenário e assim permanece como uma opção a ser considerada em situação de limitação de recursos. Esses resultados também justificam a continuidade da exploração de novos progestágenos no tratamento do câncer de mama. Palavras chave: câncer de mama, tratamento, acetato de megestrol

Safety of Megestrol Acetate in Palliating Anorexia-Cachexia Syndrome in Patients with Castration-Resistant Prostate Cancer

There are concerns whether megestrol acetate (MA) stimulates the growth of prostate cancer in castration-resistant prostate cancer (CRPC). We evaluated the effect of cumulative doses of MA on the disease-specific survival (DSS) in patients with CRPC who were receiving Docetaxel-based chemotherapy. From July 2003 through June 2009, we identified 109 consecutive patients with CRPC and who had received docetaxel-based chemotherapy. Of these patients, 68 (62.4%) have not received MA, whereas 21 patients (19.3%) and 20 patients (18.3%) had received low dose MA (total 18,400 mg), respectively. We assessed the effect of several variables on DSS. None of the clinicopathological variables differed among the three groups. When comparing DSS using Kaplan-Meier analysis, there was no statistically significant survival differences among the three groups (P = 0.546). Using multivariate Cox proportional analyses with backward elimination, the number of docetaxel cycles was only significant factor predicting DSS (HR: 0.578, 95% CI: 0.318-0.923, P = 0.016). Cumulative doses of MA as adjuvant treatment for patients with CRPC and who are receiving docetaxel-based chemotherapy, did not affect their DSS. Therefore, MA can be safely administered in cachexic patients with CRPC.

Precipitation reaction of SDS and potassium salts in flocculation of a micronized megestrol acetate suspension

In this work attempts were made to evaluate K[+]-SDS and hydrocolloid polymer-SDS interactions in flocculation of megestrol acetate dispersions to enhancetheir stability as a part of suspension formulation. Different dispersions of micronized megestrol acetate and SDS were prepared. KCl and KH[2]PO[4] and their corresponding sodium salts were added to the dispersions and the preparations were evaluated using general physicochemical and stability tests including appearance, sedimentation volume, sedimentation rate and redispersibility. Addition of polyols and hydrocolloid polymers to the SDS containing dispersions was also investigated for possible instabilities.SDS deflocculated the initial megestrol acetate dispersions. The use of potassium salts unlike the sodium salts flocculated the dispersion particles due to precipitation reaction of potassium ions and the adsorbed SDS. Additionally the uncharged hydrocolloid polymers MC and HPMC in contrast to the ionic polymers xanthan gum and NaCMC showed incompatibility due to their interaction with SDS. K[+]- SDS interactions have proved useful in protein and DNA analysis studies and we found this precipitation reaction to be applicable in flocculation of pharmaceutical suspensions containing SDS

Recent Advances in Cancer Cachexia / 종양간호학회지

PURPOSE: The study was aimed to review and understand the meaning of cancer cachexia. METHODS: Using the keywords "cachexia" and "cancer cachexia" 30 oncology research published from 1974 to 2009 were selected for the review. RESULTS: The mechanism of cancer cachexia has not been fully understood, but various pathogenesis appears to be involved in the development cachexia including altered metabolism of carbohydrate, lipid, and protein associated with cytokines and hormone. As a result, muscle strength, food intake and resting energy expenditure (REE) are reduced. Most medications for the treatment of cachexia show debating results except some drugs such as megace. Supportive care including nutritional education, nursing care, and social support are found another effective treatment options. CONCLUSION: The results of this study would help oncology nurses to understand the mechanism of cancer cachexia and its management.

Low Dose Megestrol Acetate for Maintenance Hemodialysis Patients / 대한신장학회지

PURPOSE: Maintenance hemodialysis (HD) patients have a high prevalence of malnutrition and inflammation. Megestrol acetate (MA) has been shown to increase appetite in cancer patients but the usual dose of MA (400-800 mg/day) was associated with serious side effects in HD patients. We evaluated the changes in nutritional and inflammatory parameters after low dose of MA treatment in malnourished HD patients METHODS: Inclusion criteria were maintenance HD patients who showed serum albumin <3.5 g/dL or <4.0 g/dL with anorexia. Serum chemical parameters, cytokines, Subjective Global Assessment, dry weight, Kt/V, nPCR, SF36 quality of life, fat free mass (FFM), and body fat mass (BFM) were measured. Patients were instructed to take 5 mL (200 mg) of MA solution once a day. RESULTS: Fourteen patients (seven male, age 52+/-10 years, mean HD duration 48+/-59 months) were included. One patient died of pneumonia. Seven patients dropped out because they refused to take the drug after one to three months of treatment; two of them complained of thirst, three of them ate too much, and two had both. Six patients (four male and two female) have completed six months of study. Serum albumin (3.1+/-0.5 to 3.6+/-0.4 g/dL), TIBC (184.2+/-27.9 to 205.0+/-25.8 microgram/ dL), BFM (11.9+/-5.7 to 16.6+/-7.4 kg), protein intake (57.0+/-32.5 to 68.7+/-39.2 g/day), and energy intake (1,521+/-690 to 1,724+/-879) were increased. Serum CRP and IL-6 decreased without statistical significance. No significant adverse effects were observed in all patients who had completed study. CONCLUSION: Low dose MA can improve the nutritional status, inflammation, and anorexia in maintenance HD patients.

Secondary Adrenal Insufficiency Associated with Megestrol Acetate in a Patient with Lung Cancer / 결핵및호흡기질환

Loss of appetite is an important factor in the quality of life for advanced cancer patients. Megestrol acetate is used to stimulate appetite, but it can cause suppression of the pituitary adrenal axis due to the affinity of the glucocorticoid receptor. Adrenal insufficiency is a life threatening disorder if left, untreated, but the initial clinical symptoms of the patients are vague. Awareness of the glucocorticoid-like activity of megestrol acetate and its side effects are important for the diagnosis of adrenal insufficiency. We present a case of secondary adrenal insufficiency associated with megestrol acetate in a patient with lung cancer.

Endometrial stromal sarcoma associated with extrauterine endometriosis: a case report and literature review / 부인종양

Endometrial stromal sarcoma (ESS) that arises from extrauterine endometriosis is a rare form of malignancy. We report the case of a 37-year-old ESS patient with extrauterine endometriosis who was treated with ifosfamide/cisplatin chemotherapy. A woman presented with epigastric pain and abdominal distension. Computed tomography imaging revealed a profuse amount of ascites, including a 12.4x12.3 cm sized posterior cul-de-sac mass composed of solid and cystic components. Cytoreductive surgery was performed to remove the mass and the histopathologic findings indicated ESS associated with extrauterine endometriosis. Six cycles of combination chemotherapy [ifosfamide (5 g/m(2)) with mesna (1 g/m(2)) and cisplatin (50 mg/m(2)) (IP)] were administered. After a six-month of disease-free interval, recurrent ESS developed in the pelvic cavity and in both lung fields. Megace medication decreased tumor marker CA-125 for six weeks. However, the patient expired sixteen months after the cytoreductive surgery. ESS associated with extrauterine endometriosis showed response to IP chemotherapy and megace.

Unusual causes of Cushing's syndrome: [review]

Although in the majority of the patients with Cushing's syndrome (CS), hypercortisolism is due to ACTH hypersecretion by a pituitary tumour or to ectopic ACTH secretion from an extrapituitary neoplastic lesion or to autonomous cortisol secretion by an adrenal tumour, in occasional patients a much rarer entity may be the cause of the syndrome. Herein, we attempted to summarise and categorise these unusual causes according to their presumed aetiology. To this end, we performed a comprehensive computer-based search for unusual or rare causes of CS. The following unusual forms of CS were identified: (i) ACTH hyperesecretion due to ectopic corticotroph adenomas in the parasellar region or the neurohypophysis, or as part of double adenomas, or gangliocytomas; (ii) ACTH hypersecretion due to ectopic CRH or CRH-like peptide secretion by various neoplasms; (iii) ACTH-independent cortisol hypersecretion from ectopic or bilateral adrenal adenomas; (iv) glucocorticoid hypersensitivity; (v) iatrogenic, due to megestrol administration or to ritonavir and fluticasone co-administration. Such unusual presentations of CS illustrate why Cushing's syndrome represents one of the most puzzling endocrine syndromes.

Embora na maioria dos pacientes com síndrome de Cushing (SC), o hipercortisolismo se deva à hipersecreção de ACTH resultante de um tumor hipofisário ou de uma fonte ectópica de ACTH por uma lesão neoplásica extra-hipofisária, ou ainda pela secreção autônoma de cortisol por um tumor adrenal, ocasionalmente uma entidade muito mais rara pode ser a causa da síndrome. Nesta revisão, tentaremos sumarizar e categorizar essas causas incomuns de acordo com sua pressuposta etiologia. Para isso, fizemos uma ampla pesquisa por computador em busca dessas causas raras ou não usuais de SC. As seguintes formas não usuais de SC foram identificadas: (i) hipersecreção de ACTH devida a adenomas corticotróficos ectópicos na região parasselar ou na neuro-hipófise, ou como parte de adenomas duplos, ou gangliocitomas; (ii) hipersecreção de ACTH devida à secreção ectópica de CRH ou peptídeo CRH-símile por várias neoplasias; (iii) hipersecreção de cortisol ACTH-independente por adenomas adrenais ectópicos ou bilaterais; (iv) hipersensibilidade aos glicocorticóides; (v) iatrogênica, devida à administração de megestrol ou à co-administração de ritonavir e fluticasona. Essas apresentações incomuns da SC ilustram por que essa síndrome é considerada uma das mais desafiadoras da endocrinologia.

Thrombosis in Patients with Acquired Immunodeficiency Syndrome

Patients with HIV infection may be at increased risk of thrombosis. A variety of mechanism have been proposed to account for hypercoagulability in HIV-infected patients. These include decreased plasma concentrations of protein S, opportunistic infection, tumor such as Kaposi's sarcoma, drugs such as megestrol acetate, protease inhibitor, and presence of anticardiolipin antibody. The authors report three cases of thrombosis in AIDS patients. One case was renal vein thrombosis associated with abnormalities of protein S and anticardiolipin IgG. Two cases were pulmonary embolism associated with megestrol acetate.

Thrombosis in Patients with Acquired Immunodeficiency Syndrome

Patients with HIV infection may be at increased risk of thrombosis. A variety of mechanism have been proposed to account for hypercoagulability in HIV-infected patients. These include decreased plasma concentrations of protein S, opportunistic infection, tumor such as Kaposi's sarcoma, drugs such as megestrol acetate, protease inhibitor, and presence of anticardiolipin antibody. The authors report three cases of thrombosis in AIDS patients. One case was renal vein thrombosis associated with abnormalities of protein S and anticardiolipin IgG. Two cases were pulmonary embolism associated with megestrol acetate.

Treatment efficacy of high dose progestin in young women with early stage of endometrial carcinoma / 대한산부인과학회지

OBJECTIVE: The aim of this study is to investigate the effectiveness of high dose progestins in young patients with early stage of endometrial cancer. METHODS: Between April 1998 and December 2005, 10 women with early stage of endometrial carcinoma were treated with high dose progestins as primary therapy for the purpose of saving fertility. RESULTS: They took 80~160 mg of megestrol acetate or 500~1,000 mg of medroxyprogesterone acetate per day, and then followed up with the endometrial curettages. Seven patients (70.0%) responded to the treatment. Three patients didn't respond and so underwent hysterectomy as definite treatment. Four patients were able to become pregnant after completing treatment. No patients died of their disease. CONCLUSION: The majority of patients with well-differentiated endometrial adenocarcinoma who underwent conservative treatment with a progestational agent responded to the treatment. High-dose progestin therapy can be used as primary therapy in selected young women with early stage of endometrial carcinoma.

A successful twin pregnancy after conservative therapy of endometrial cancer / 대한산부인과학회지

Endometrial cancer is increasing in South Korea. In young women, endometrial cancer can be treated by progestins for preserving fertility. We experienced a successful case of twin pregnancy after conservative therapy of endometrial cancer with Megestrol acetate. Ovulation induction and intrauterine insemination was done. A brief review of related literature was done.

Progesterone-modulated proteins in human endometrial cancer cell line Ishikawa / 南方医科大学学报

<p><b>OBJECTIVE</b>To identify proteins associated with growth inhibitory effects of progesterone in Ishikawa endometrial adenocarcinoma cell line (Ishikawa).</p><p><b>METHODS</b>The total cellular proteins of the control and megestrol acetate (MA)-treated Ishikawa cells were separated by two-dimensional gel electrophoresis. After colloidal Coomassie G-250 staining and scanning, the gel images were analyzed by PDQuest software. Matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry (MALDI-TOF MS) and Mascot software were used to identify the differentially expressed protein.</p><p><b>RESULTS AND CONCLUSIONS</b>Well-resolved and reproducible 2-dimensional patterns of both control and MA-treated Ishikawa cells were obtained. Forty-one proteins displayed differential expression after MA treatment, among which 23 were up-regulated and 18 down-regulated. Peptide mass fingerprints (PMF) by MALDI-TOF-MS analysis and search in NCBInr resulted in the identification of 8 proteins. The up-regulated proteins identified were catechol-O-methyltransferase (COMT), glutathione S-transferase, keratin 8, splicing factor 3a (subunit 3), chaperonin containing TCP1 (subunit 6A isoform a, CCT6A), RAB6A protein and AHA1. The down-regulated protein was peptidyl prolyl isomerase A (isoform 1). These findings can be helpful in further investigation of the molecular mechanism of progesterone.</p>