Maintenance hormonal therapy after treatment with medroxyprogesterone acetate for patients with atypical polypoid adenomyoma

Abstract

Background: As atypical polypoid adenomyoma (APA) has been reported to be a hormone-related tumor, we aimed to analyze the efficacy and safety of maintenance hormonal therapy after fertility-preserving treatment of these patients with medroxyprogesterone acetate (MPA). Methods: Data were retrospectively analyzed from patients with APA who were treated with a fertility-preserving regimen including MPA between October 2001 and December 2011. Eighteen patients were treated with MPA and 14 (77.8%) achieved either a complete or a partial response after the planned treatment. Five patients took progestin for maintenance therapy. Results: Eighteen patients were treated for a mean observation period of 96.7 months. While taking the maintenance therapy, no patient had APA relapse. One patient developed welldifferentiated endometrioid adenocarcinoma 18 months after she stopped taking maintenance progestin. Eleven patients without maintenance therapy underwent hysterectomy, andnine of them developed well-differentiated endometrial cancer. Through univariate analysis, there was a significant difference in time to hysterectomy between patients with and without maintenance therapy (P = 0.015). Through multivariate analysis, body mass index (BMI), menstrual status before protocol therapy, maintenance treatment, and pregnancy were found to be significantly associated with a lower risk of hysterectomy. No patient had a recurrence of APA after hysterectomy during the observation period (median, 54 months; range, 2-148 months). Conclusion: No patient showed progression while receiving hormonal therapy, including initial protocol therapy. Maintenance hormonal therapy after treatment with MPA was highly effective and safe, particularly in patients with BMI ≧24 kg/m 2 and irregular menstruation cycle.

Management of women with atypical polypoid adenomyoma of the uterus: A quantitative systematic review

“…Thirteen studies were assessed for eligibility; after applying exclusion criteria, two of them were excluded. The last 11 retrospective studies with a total of 237 APA were included in the quantitative systematic review . Two of the included studies reported overlapping data and were considered as one study in the data analysis.…”

“…For the “unbiased assessment of the study endpoint” domain, five studies were categorized as low risk of bias since they performed histological examination at every follow‐up visit . Six studies were classified as unclear risk because they performed histological examination only when ultrasonographic findings were suspicious, or if they did not specify whether histological examination was performed at every follow‐up visit …”

“…In three studies, the follow up of patients conservatively treated was based on D&C or hysteroscopic biopsy and transvaginal ultrasonography every 3‐6 months . In three other studies, hysteroscopic biopsy were performed only when ultrasonographic findings were suspicious .…”

“…In fact, both modality and timing of follow up were different among the studies. In three studies, D&C or hysteroscopic specimens were obtained only in the case of suspicious findings on ultrasonography, whereas in the other studies, histological examination was performed at every follow‐up visit. Given the risk of recurrence, progression and coexistent atypical hyperplasia and/or cancer, we think that a close follow up based on histological examination would be advisable.…”

“…However, since APA affects premenopausal women in most cases, a fertility‐sparing approach appears necessary. Several conservative treatments have been adopted, including progestin‐based hormonal therapy (HT) with or without maintenance (M), hysteroscopic transcervical resection (TCR), dilation and curettage (D&C) or the combination of HT with TCR or D&C …”