Hyperinsulinemia as a factor modifying sensitivity of endometrial carcinoma to hormonal influences.

In 22 patients with endometrial carcinoma, Stage I-III (mean age 57.8 years) with obesity, initial and reactive hyperinsulinemia (during glucose load) was revealed. Significant correlations between values of "peak" and field-square of the insulin secretion curve and cytoplasmatic receptors to Estradiol and Progesterone in the tumor were found. In a group of the patients with high values of reactive hyperinsulinemia significantly larger amounts of steroid hormone receptors in the tumor were determined as compared to the group of the patients who had low insulinemia values. On considering these data a possible conclusion was reached as to the modifying influence of hyperinsulinemia on sensitivity of endometrial carcinoma to hormone receptor synthesis in the tumor by insulin.

Criteria of endometrial carcinoma sensitivity to hormone therapy: pathogenetic type of the disease and the tumor reaction to tamoxifen.

The results of assay of receptorial status of tumor in 152 primary patients with endometrial carcinoma are presented. It was shown that a 10-day course of preoperative Tamoxifen therapy (course dose 0.6 g) was able to increase significantly concentrations of nuclear estradiol receptors and cytoplasmatic progesterone receptors in the tumor. This phenomenon followed morphological changes in the tumor and was established in both hormone dependent type (72.7%) and hormone independent type of endometrial carcinoma (45.5%). The assay of the dynamics of receptorial status of primary endometrial carcinoma under influence of Tamoxifen before surgery might be an informative test for selection of sensitive patients with poor prognosis for prolonged hormone therapy in remission to prevent development of recurrencies.

Favourable influence of adjuvant hormone therapy by oxyprogesterone caproate (OPC) and by its combination with tamoxifen on 5-year survival rate of surgical and combined treatment of primary endometrial carcinoma patients.

In a prospective and randomized study comprising 540 primary endometrial carcinoma patients the influence of adjuvant hormone therapy by Oxyprogesterone caproate (OPC) and by its combination with Tamoxifen on the corrected survival rates after surgical and combined (surgical and irradiation) therapy was investigated. As was shown OPC administered preoperatively and after surgical and combined therapy from 6 up to 36 months increased the corrected survival rates as compared with that in patients who did not receive hormone treatment. Combination of OPC and Tamoxifen administered additionally to surgical and combined therapy increase the corrected survival rate at the 5th year by 19%. One can conclude that adjuvant hormone therapy in endometrial carcinoma patients who have unfavourable prognosis of the disease must be administered for not less than 3 years in order to obtain prolongation of remission of the disease.

Effect of oxyprogesterone caproate, tamoxifen and their combination on the level of steroid hormone receptors in the tumor, and some parameters of the reproductive system in patients with endometrial cancer.

The results of preoperative use of oxyprogesterone caproate (OPC), Tamoxifen and their combination in 165 patients suffering from primary endometrial carcinoma are presented. It was shown that Tamoxifen was able to increase concentrations cytoplasmatic receptors to progesterone in the tumor. The incidence of specific hormonal pathomorphosis in the tissue of the tumor in patients who received a combination of OPC and Tamoxifen was significantly higher (80% of cases) as compared to the separate use of OPC (60%) or Tamoxifen (57%).

Myoma uterus as a marker of oncogynecological pathology in pre- and post-menopause.

Development and (or) growth of myoma uteri in pre- and post-menopause is accompanied by hyperestrogenia which is shown by histological investigation of the endometrium and the ovaries. A comparative clinical and morphological study of 853 patients with myoma uteri, 996 patients with glandular, atypical hyperplasia and endometrial carcinoma was carried out. Benign tumors of the ovaries were revealed in 9.5% of patients with myoma, 12.7% of patients with atypical endometrial hyperplasia and 19.8% of patients with endometrial cancer. A significant increase of the occurrence of endometrial cancer in postmenopausal patients with myoma, in comparison with patients in the reproductive period was determined, 13.4% and 1.1% respectively, P = 0.01. In postmenopause "growth" of the tumor was more often and significantly simulated by malignant disease of the uterus and adnexa. In postmenopausal patients with myoma and uterine bleeding, endometrial carcinoma was 5.5 times more often revealed in comparison with the analogous group of patients in the reproductive period. The "relative risk" of the development of endometrial cancer, sarcoma uteri and ovarian tumors was calculated. The "relative risk" was shown to increase in the postmenopausal period. In the processes of observation of patients with myoma in postmenopause, cytological investigation of endometrial aspirates, ultrasound and mammographic screening should be carried out.

Can primary endometrial carcinoma stage I be cured without surgery and radiation therapy?

The data on 19 cases of primary endometrial carcinoma, stage I (mean age 28.0 years), cured by the administration of hydroxyprogesterone caproate without surgery and radiation therapy are presented. Clinical recovery in 15 cases was confirmed by repeated cytological and histological examinations of the endometrium. Hydroxyprogesterone caproate dose per course ranged within 25.0-83.0 g. In 4 patients with moderately differentiated cancer (G2), hormonal treatment was carried out in combination with chemotherapy. When tumor regression was confirmed histologically, steroid contraceptives were administered to induce an artificial menstrual cycle. At the closing stage of therapy clomiphene citrates were given in succession to restore the ovulatory cycle. Perspectives of administration of progestogens in young women with stage I endometrial carcinoma as a separate method of therapy are discussed.