Estramustine phosphate in the treatment of endometrium carcinoma

Abstract

Objective: To study the clinical effects and side effects of Estramustine phosphate (EMP) on the treatment of endometrial carcinoma. Methods: Fifty-eight patients with endometrial carcinoma diagnosed in our hospital from Oct. 1996 to Feb. 1998 were randomly divided into 3 groups and clinically observed. EMP group (n=21): after oral EMP 280 mg, bid, for 21 days, surgical operation followed in one week. Radiotherapy (RT) group (n=19): surgical operation was preformed after intra-cavity irradiation with half of the standard dosage. Control group (n=18): surgical operation alone. Histopathological changes in the samples from the removed uterus were observed. Estrogen receptor/progestin receptor (ER/PR) and nuclear proliferate antigen (ki-67) index of the endometrial carcinoma tissues of the EMP group were tested by immunohistochemical methods. Results: The microscopic changes induced by irradiation were much heavier than those induced by chemotherapy. In EMP group, 5/21 cases were found with no tumor lesion in the postoperation samples, all of those 5 cases being with ER strong positive (++) and 4/5 cases well differentiated tumor before chemotherapy. In RT group, the tumor lesion was disappeared in 6/19 cases, and 5 cases of which being with the moderate differentiation. No significant difference was shown between those two groups. No any histopathological changes were seen in control group. Immunohistochemical tests revealed a significant decrease in ER staining after EMP treatment and a decrease in ki-67 index, especially for the ER positive tumors, ki-67 index reduced significantly from 49.5% before medication to 35.1% after medication (P<0.05). Only 5 cases in EMP group reported slight nausea and vomit at the beginning of taking medicine. No changes in body weight, blood pressure, WBC count, or liver and kidney functions were seen at all. However, some patients experienced symptoms and signs such as darkening of areola and perineum, an increase in vaginal discharge, breast discomfort, significant increase of serum E₂ level, reduction of GnH level, and rise of TG and HDL, all of which disappeared after stop the medication. Conclusion: EMP has the effect for treating endometrial carcinoma, especially for ER-positive carcinoma. Increase of estrogen level dominates the side effects with slight and tolerable degree.