***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Objective To evaluate oncologic and reproductive outcome with levonorgestrel-releasing intrauterine system combined with gonadotropin-releasing hormone agonist in women with grade 1 endometrial carcinoma , and the levonorgestrel monotherapy in women with complex atypical hyperplasia . Material s/ Methods A prospect i ve study was conducted . We analyzed the clinical characteristics of 70 patients younger than 42 years ( mean age , 33 years ) with a diagnosis of complex atypical endometrial hyperplasia ( AEH ) or grade 1 endometrial adenocarcinoma who were treated with hormonal therapy at the Division of Gynecologic Oncology of P.A. Hertsen Moscow Cancer Research Institute from February 2009 to December 2012 . Patients with complex AEH received monotherapy with levonorgestrel-releasing intrauterine system ( Mirena , Shering , Finl and ; 52 mg ) . Patients with a diagnosis of grade 1 endometrial cancer were treated with levonorgestrel-releasing intrauterine system combined with gonadotropin-releasing hormone agonist ( Zoladex ; AstraZeneca UK Limited , UK ; 3.6-mg depot ) . All the patients received hormonal therapy for a minimum of 6 months . Pretreatment evaluation consisted of transabdominal and transvaginal ultrasound in grayscale , color Doppler ultrasound , contrast-enhanced magnetic resonance imaging , cervical hysteroscopy , Pipelle endometrial biopsy , and morphological and immunohistochemical characteristics of the tissue . Results Seventy patients were included in study analyses . Twenty three ( 72 % ) of 32 patients with adenocarcinoma and 35 ( 92 % ) of 38 patients with AEH had complete remission , defined as the absence of any carcinoma or hyperplasia on endometrial sampling specimens . Among these cases , 2 patients with adenocarcinoma and 1 patient with AEH had recurrence after their complete response . Nine patients had persistent disease . Eight patients had 10 conceptions , result ing in 8 live births . Conclusions The suggested conservative treatment strategy can be considered as a valid therapeutic option for young women of childbearing potential with atypical endometrial hyperplasia and grade 1 endometrial adenocarcinoma who wish to preserve their fertility and thus may be recommended as an alternative to hysterectomy . Close follow-up during and after the treatment period is strictly required Objective : The aim of this study was to evaluate fertility-sparing therapy in young patients with endometrial carcinoma . Methodology : This prospect i ve study was carried out on 8 patients with clinical and radio-graphic stage IA , well differentiated endometrioid adenocarcinoma of the endometrium in Alzahra hospital , Tabriz , Iran . Treatment comprised high-dose megestrol acetate . Dilatation and curettage was repeated every three months . Results : The mean age of the patients was 30 ( SD,3.21 ) years ( range 24 - 35 ) . Of the 8 patients , 7 ( 87.5 % ) achieved complete response . The mean time to response was 6.5 months ( range 3 - 9 ) . Of the complete responders , 3 of 7(42.8 % ) had recurrence ; one patient underwent immediate hysterectomy , and 2 were successfully treated with second-line therapy and both subsequently conceived . Conception occurred in 3 of 7 patients ( 42.8 % ) , in two more than once , However successful pregnancy occurred only in two patients . One patient developed Concomitant ovarian adenocarcinoma . Conclusions : High dose progestin therapy can be an effective fertility-sparing treatment in young patients with well differentiated stage IA endometrial endometrioid cancer confined to endometrium . However , close follow up is required because of risks of conservative treatment OBJECTIVE To evaluate the safety of fertility-sparing hormonal therapy for endometrial cancer in young patients . METHODS Six patients diagnosed with endometrial adenocarcinoma grade I and had undergone progestin treatment were review ed . Four patients failed progestin treatment and were then found at surgery to have both endometrial and ovarian cancers . A clonality assay using the human and rogen receptor gene as the X-linked polymorphic marker and immunohistochemistry for steroid hormone receptor expression were used to delineate the relation between the endometrial and ovarian lesions and to explore possible causes of treatment failure . RESULTS The patients were followed for a mean of 48.8 months . Four of the six responded to the treatment at a mean of 3.5 months . Two of these patients had a recurrence within a mean of 4.5 months after their initial response . Two patients did not respond to progestin treatment . At surgery in those 4 , both endometrial and ovarian tumors were found . All 6 are still alive , and 2 successfully delivered healthy infants . The clonality assay revealed an independent cell origin for the endometrial and ovarian lesions in 2 of the 4 women who failed progestin treatment . Progesterone receptors were absent in both endometrial and ovarian tumors in 2 of these 4 patients . CONCLUSION The absence of progesterone receptors may relate to the failure of progestin treatment . The use of progestin treatment for well-differentiated early endometrial carcinoma should be cautious and requires very careful clinical evaluation before and after treatment BACKGROUND Metformin , widely used in the treatment of type 2 diabetes mellitus , reduces the risk of cancer and relapse after treatment . Fertility-sparing treatment for endometrial cancer ( EC ) with progestin is associated with a high chance of disease regression , and the high relapse rate continues to be a problem . We assessed the efficacy of metformin in preventing recurrence after medroxyprogesterone acetate ( MPA ) as fertility-sparing treatment for atypical endometrial hyperplasia ( AEH ) and EC . PATIENTS AND METHODS This phase II study enrolled 17 patients with AEH and 19 patients with EC limited to the endometrium ( age , 20 - 40 years ) .  MPA ( 400 mg/day ) and metformin ( 750 - 2250 mg/day ) were administered for 24 - 36 weeks to achieve a complete response ( CR ) . Metformin was administered until conception , even after MPA discontinuation . The primary end point was relapse-free survival ( RFS ) after remission . We analyzed all efficacy end points in the full analysis set . RESULTS The body mass index was ≥25 kg/m(2 ) in 27 patients ( mean , 31 kg/m(2 ) ; range , 19 - 51 kg/m(2 ) ) , and the homeostasis model assessment for insulin resistance index was ≥2.5 in 24 patients ( mean , 4.7 ; range , 0.7 - 21 ) . Two patients showed progression at 12 weeks [ 6 % ; 95 % confidence interval ( CI ) 2 - 18 ] . At 36 weeks , 29 ( 81 % ; 95 % CI 65 - 90 ) patients achieved CR , and 5 ( 14 % ; 95 % CI 6 - 29 ) patients achieved partial response . During a median follow-up of 38 months ( range , 9 - 66 months ) after remission , relapse was confirmed in three of the patients who had achieved CR ( relapse rate , 10 % ) . The 3-year estimated RFS rate was 89 % . No patients experienced severe toxicity . CONCLUSIONS Metformin inhibited disease relapse after MPA therapy . The combination of metformin and MPA in EC treatment should be studied further . TRIAL REGISTRATION NUMBER UMIN 000002210 Objective To determine whether less invasive endometrial ( EM ) aspiration biopsy is adequately accurate for evaluating treatment outcomes compared to the dilatation and curettage ( D&C ) biopsy in early-stage endometrial cancer ( EC ) patients treated with high dose oral progestin and levonorgestrel intrauterine system ( LNG-IUS ) .  Methods We conducted a prospect i ve observational study with patients younger than 40 years who were diagnosed with clinical stage IA , The International Federation of Gynecology and Obstetrics grade 1 or 2 endometrioid adenocarcinoma and sought to maintain their fertility . The patients were treated with medroxyprogesterone acetate 500 mg/day and LNG-IUS .  Treatment responses were evaluated every 3 months . EM aspiration biopsy was conducted after LNG-IUS removal followed D&C. The tissue sample s were histologically compared . The diagnostic concordance rate of the two tests was examined with κ statistics . Results Twenty-eight pairs of EM sample s were obtained from five patients . The diagnostic concordance rate of D&C and EM aspiration biopsy was 39.3 % ( κ value=0.26 ) . Of the seven sample s diagnosed as normal with D&C , three ( 42.8 % ) were diagnosed as normal by using EM aspiration biopsy . Of the eight sample s diagnosed with endometrioid adenocarcinoma by using D&C , three ( 37.5 % ) were diagnosed with endometrioid adenocarcinoma by using EM aspiration biopsy . Of the 13 complex EM hyperplasia sample s diagnosed with the D&C , five ( 38.5 % ) were diagnosed with EM hyperplasia by using EM aspiration biopsy . Of the sample s obtained through EM aspiration , 46.4 % were insufficient for histological evaluation . Conclusion To evaluate the treatment responses of patients with early-stage EC treated with high dose oral progestin and LNG-IUS , D&C should be conducted after LNG-IUS removal Objective To examine the relation between body mass index ( kg/m2 ) and  cancer incidence and mortality . Design Prospect i ve cohort study . Participants 1.2 million UK women recruited into the Million Women Study , aged 50 - 64 during 1996 - 2001 , and followed up , on average , for 5.4 years for cancer incidence and 7.0 years for cancer mortality . Main outcome measures Relative risks of incidence and mortality for all cancers , and for 17 specific types of cancer , according to body mass index , adjusted for age , geographical region , socioeconomic status , age at first birth , parity , smoking status , alcohol intake , physical activity , years since menopause , and use of hormone replacement therapy . Results 45 037 incident cancers and 17 203 deaths from cancer occurred over the follow-up period . Increasing body mass index was associated with an increased incidence of endometrial cancer ( trend in relative risk per 10 units=2.89 , 95 % confidence interval 2.62 to 3.18 ) , adenocarcinoma of the oesophagus ( 2.38 , 1.59 to 3.56 ) , kidney cancer ( 1.53 , 1.27 to 1.84 ) , leukaemia ( 1.50 , 1.23 to 1.83 ) , multiple myeloma ( 1.31 , 1.04 to 1.65 ) , pancreatic cancer ( 1.24 , 1.03 to 1.48 ) , non-Hodgkin 's lymphoma ( 1.17 , 1.03 to 1.34 ) , ovarian cancer ( 1.14 , 1.03 to 1.27 ) , all cancers combined ( 1.12 , 1.09 to 1.14 ) , breast cancer in postmenopausal women ( 1.40 , 1.31 to 1.49 ) and colorectal cancer in premenopausal women ( 1.61 , 1.05 to 2.48 ) . In general , the relation between body mass index and mortality was similar to that for incidence . For colorectal cancer , malignant melanoma , breast cancer , and endometrial cancer , the effect of body mass index on risk differed significantly according to menopausal status . Conclusions Increasing body mass index is associated with a significant increase in the risk of cancer for 10 out of 17 specific types examined . Among postmenopausal women in the UK , 5 % of all cancers ( about 6000 annually ) are attributable to being overweight or obese . For endometrial cancer and adenocarcinoma of the oesophagus , body mass index represents a major modifiable risk factor ; about half of all cases in postmenopausal women are attributable to overweight or obesity Objective The aim of this study is to assess the effectiveness of oral progestin treatment in women diagnosed with complex atypical hyperplasia ( CAH ) or grade 1 endometrial cancer ( G1EC ) , who desire to preserve their fertility , as alternative treatment to a hysterectomy . Methods We review ed the medical records of women younger than 45 years old that had been diagnosed with CAH or G1EC , who expressed a desire to preserve their fertility using alternative treatment at our institution . Women without evidence of myometrial invasion on pelvic magnetic resonance imaging scans were included . The study period was between 2004 and 2014 . Endometrial biopsies were taken at follow-up appointments . Results We identified 31 young women with CAH or G1EC . The median age was 33 years old ( range , 20 to 41 ) , and the median period of time undertaking the treatment was 5 months ( range , 1 to 12 ) . Twenty-three patients ( 74.2 % ) achieved complete remission ( CR ; median time to CR was 3 months 
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Conclusion : In general , patients with CAH or early-stage EC who were treated with  progesterone therapy had a favorable prognosis .
However , the recurrence risk was not insignificant .