Conservative Treatment With Progestin and Pregnancy Outcomes in Endometrial Cancer

Hahn, Hyung Jin; Yoon, Soon‐Gil; Hong, Jae-Shik; Hong, Sungchul; Park, Sei-Jin; Lim, Ju Young; Kwon, Young-Soon; Lee, In-Ho; Lim, Kyung-Taek; Lee, Ki-Heon; Shim, Jaewoo; Mok, Jung Eun; Kim, Tae-Jin

doi:10.1111/igc.0b013e3181aae1fb

Cited by 101 publications

(57 citation statements)

References 19 publications

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“…Studies at various institutions have reported the results of fertility-sparing treatment for EC using progesterone preparations (8)(9)(10)(11)(12)(13)(14)(15)(16)(17). However, as the number of cases have been low, the efficacy of such treatment has yet to be clarified.…”

Section: Introductionmentioning

confidence: 99%

Fertility-sparing treatment using medroxyprogesterone acetate for endometrial carcinoma

et al. 2012

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Abstract. The purpose of this study was to present the results of fertility-sparing treatment using medroxyprogesterone acetate (MPA) for endometrial carcinoma (EC), and to clarify patient characteristics by investigating patient background factors. A total of 59 patients with EC, who received MPA as fertility-sparing therapy at two institutions over a 21-year period between 1987 and 2008, were studied retrospectively. Patients were administered oral MPA at 400-600 mg/day for 16-24 weeks as long as they responded. Endometrial tissue was assessed twice, at 8-12 weeks (during treatment) and shortly after treatment. The overall complete response (CR) rate was 71%. A total of 22 (52%) of 42 responders later developed relapse. A total of 19 cases became pregnant, and 25 infants were born. Eighty percent of recurrences occurred within 2 years. For stages Ⅰa and Ⅰb-Ⅱa (FIGO, 1988), initial CR rates were 80.0 and 42.9%, respectively (p<0.01), demonstrating a significant difference. Total hysterectomy was performed for 26 patients (44%) due to recurrence or failure to respond to the initial treatment. Among these 26 patients, postoperative stages were more advanced in 10 patients (38%). The grade advanced (became more poorly differentiated) postoperatively in 2 patients (8%). Premenopausal females with EC can be treated successfully with MPA, however patients should be informed of the risks and limitations of this conservative treatment. IntroductionIn Western countries, endometrial carcinoma (EC) is the most common type of malignant tumor in the field of gynecology (1,2). A state of persistent high estrogen, as observed with ovulation disorders and obesity, is considered a risk factor (3-5). The standard treatments for EC are total hysterectomy and bilateral adnexectomy.EC is a disease that frequently affects perimenopausal females, however approximately 10% of affected females are ≤40 years old, and the incidence in young females has recently been on the increase (6). As in Western countries, the number of ≤40-year-old females with EC in Japan is on the rise (7). Thus, the number of patients who select to undergo fertilitysparing treatment is growing.Studies at various institutions have reported the results of fertility-sparing treatment for EC using progesterone preparations (8-17). However, as the number of cases have been low, the efficacy of such treatment has yet to be clarified. Furthermore, few studies have closely described the clinical background of young females with early-stage EC wishing to undergo fertility-sparing treatment.The present study investigated the effects of treatment, prognosis, pregnancy status and other factors, in order to demonstrate the therapeutic outcomes of current fertility-sparing treatment. Furthermore, patient background factors were investigated to elucidate the characteristics of the patient group. Patients and methods Patients.A total of 59 patients with EC who underwent fertilitysparing treatment, at either the Jichi Medical University Hospital or the Kitasato University Hospit...

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Section: Introductionmentioning

confidence: 99%

Fertility-sparing treatment using medroxyprogesterone acetate for endometrial carcinoma

et al. 2012

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“…Today exist the possibility to detect early stage well-differentiated tumors that can be treated with resection of the lesion and progestin therapy. (29) Epithelial ovarian cancer continues to be treated radically with loss of reproductive organs. But increasing understanding of germ cell malignancies, borderline tumours of the ovary and epithelial tumors at stage IA grade I, has led to a more conservative approach to these neoplasms and often a single oophorectomy will be performed where in the past, a hysterectomy and/or bilateral oophorectomy would have been the treatment of choice.…”

Section: Surgical Managementmentioning

confidence: 99%

Fertility Preservation in Gynecologic Cancers Patients

Farfalli¹,

Ferreyra²

2012

Basic Gynecology - Some Related Issues

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“…A review of 99 women treated within nine different studies reported an overall complete response rate of 54% with a total of 37 live births [8]. More recently, response rates of 55-63% have been reported with the use of high-dose progestogens [9,10]. Even higher responses of up to 82% are reported for atypical hyperplasia [9].…”

Section: Fertility-sparing Treatmentmentioning

confidence: 99%

Unresolved issues in the management of endometrial cancer

Holland¹

2011

Expert Review of Anticancer Therapy

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Endometrial cancers are the most common gynecological malignancies in developed countries. Surgery is the main treatment modality but radiotherapy and, increasingly, chemotherapy are used to treat women with advanced disease and those at high risk of recurrence. Although the treatment of endometrial cancer is becoming increasingly evidence based, there remains a lack of consensus in several aspects of management. These include issues related to the type and extent of surgery and the role of adjuvant treatments as well as more conservative treatment options for younger women. This article discusses these unresolved issues, the current evidence in these areas, and highlights where current research is attempting to answer some of the outstanding questions.

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Conservative Treatment With Progestin and Pregnancy Outcomes in Endometrial Cancer

Abstract: Conservative treatment with progestin can be considered a good therapeutic option in patients with well-differentiated early-stage endometrioid endometrial adenocarcinoma who wish to preserve their uteri or become pregnant.

Cited by 101 publications

References 19 publications

Fertility-sparing treatment using medroxyprogesterone acetate for endometrial carcinoma

Fertility-sparing treatment using medroxyprogesterone acetate for endometrial carcinoma

Fertility Preservation in Gynecologic Cancers Patients

Unresolved issues in the management of endometrial cancer

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