Oral Progestin Treatment for Early-Stage Endometrial Cancer: A Systematic Review and Meta-analysis

Qin, Yun; Yu, Zhizhi; Yang, Jiaxin; Cao, Dongyan; Yu, Mei; Wang, Yanhong; Shen, Keng

doi:10.1097/igc.0000000000000723

Cited by 49 publications

(46 citation statements)

References 48 publications

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“…Conversely, two recurrences were recorded in patients who had successfully finished their pregnancies. The median number of D&C undergone by those who gave birth was three (range, [3][4][5][6][7][8][9]. No cases of placenta accreta were recorded.…”

Section: Pregnancies After Mpa Treatmentmentioning

confidence: 99%

“…For this reason, the use of high‐dose oral medroxyprogesterone acetate (MPA) as a fertility‐sparing treatment for EC and AEH has attracted interest. Although oral progestin treatment including MPA can achieve a complete response in many patients, a high rate of recurrence has been reported . Hysterectomy is often recommended to patients with recurrence, but almost all of these patients are reluctant to undergo the procedure following only a single relapse, with many requesting the re‐administration of MPA.…”

Section: Introductionmentioning

confidence: 99%

“…Although oral progestin treatment including MPA can achieve a complete response in many patients, a high rate of recurrence has been reported. 4 Hysterectomy is often recommended to patients with recurrence, but almost all of these patients are reluctant to undergo the procedure following only a single relapse, with many requesting the readministration of MPA. Although Park et al previously reviewed 73 cases with MPA retreatment, 5 obstetric outcomes were not described, and further accumulation of cases is still required.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy of medroxyprogesterone acetate treatment and retreatment for atypical endometrial hyperplasia and endometrial cancer

Tamauchi

Kajiyama

Utsumi

et al. 2017

J of Obstet and Gynaecol

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Aim: Medroxyprogesterone acetate (MPA) is used to preserve fertility in patients with Grade 1 endometrial cancer without myometrial invasion (G1EA) and those with atypical endometrial hyperplasia (AEH). However, the efficacy of retreatment with MPA has not been sufficiently established for patients who experience recurrence but wish to retain their fertility. This study aimed to show the effectiveness of MPA treatment and retreatment for AEH and G1EA. Methods: A total of 39 patients received MPA treatment between 2005 and 2015, including nine with G1EA and 30 with AEH. The patients received high-dose (600 mg/day) MPA for 26 weeks. If a complete response was not achieved, MPA treatment was continued. After complete remission, if there was a recurrence, the patient was offered a choice of a hysterectomy or retreatment with MPA. The gynecologic and obstetric outcomes were retrospectively analyzed. Results: The median age was 34 years, and the median body mass index was 23.3 kg/m 2 . The median follow-up period was 52 months. Complete response rates for the initial treatment were 89% for G1EA and 93% for AEH. Recurrence occurred in 88% of patients with G1EA (7/8) and 50% of those with AEH (14/28). Seven patients with G1EA and 11 with AEH received MPA retreatment, and 100% and 92% of these achieved a complete response. During the study period, a total of 14 pregnancies were recorded with 10 live births. Conclusion: MPA can be effective for G1EA and AEH treatment even when they recur.

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Section: Pregnancies After Mpa Treatmentmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Efficacy of medroxyprogesterone acetate treatment and retreatment for atypical endometrial hyperplasia and endometrial cancer

Tamauchi

Kajiyama

Utsumi

et al. 2017

J of Obstet and Gynaecol

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“…Previous literature shows that oral progestin therapy can achieve CR rates ranging between 67 and 80% (4-8). Our recent metaanalysis found that among 445 grade 1 stage IA EC patients who administered oral progestin, the remission rate was 82.4% (10). The pregnancy rate was 28.8%, and the recurrence rate was 25% (10).…”

Section: Discussionmentioning

confidence: 98%

“…Our recent metaanalysis found that among 445 grade 1 stage IA EC patients who administered oral progestin, the remission rate was 82.4% (10). The pregnancy rate was 28.8%, and the recurrence rate was 25% (10). The differentiation degree of EC is the most important indicator to predict stage and response to progestin treatment (11).…”

Section: Discussionmentioning

confidence: 99%

Fertility-Sparing Treatment in Young Patients With Grade 2 Presumed Stage IA Endometrioid Endometrial Adenocarcinoma

Wang

Yuan

et al. 2020

Front. Oncol.

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Purpose: To investigate the efficacy of fertility-sparing treatment for young women with grade 2 presumed stage IA endometrioid endometrial adenocarcinoma (EEA). Methods: We performed a retrospectively review of eight patients affected by grade 2 presumed stage IA endometrioid endometrial adenocarcinoma who underwent fertility-sparing treatment in the Peking Union Medical College Hospital between 2011 and 2018. Results: The median age of patients was 26 years (range, 22-35 years). Complete response (CR) was found in seven of the eight cases. The median time to response was 3 months (range, 3-9 months). Among patients who achieved CR, three had recurrence and were treated with second-line fertility-sparing therapy. Two of the three recurrent patients achieved CR, and one patient subsequently conceived. Pregnancies and successful deliveries were achieved in two of four patients. The average follow-up period was 31 months (range, 21-77 months). Conclusions: Fertility-sparing therapy is a feasible treatment option in patients with presumed stage IA, grade 2 endometrial cancer. Although our results are encouraging, they are based on very limited numbers, and patients should be informed the risk of tumor progression during treatment. Further evaluations are still required before recommending fertility-sparing therapy to endometrial cancer patients with more advanced disease in routine practice.

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Analysis of assisted reproductive outcomes in patients with atypical endometrial hyperplasia and early‐stage endometrial cancer after fertility‐sparing treatment

Li,

et al. 2024

Intl J Gynecology & Obste

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ObjectiveTo explore the assisted reproductive outcomes of patients with atypical endometrial hyperplasia (AEH) and early‐stage endometrial cancer (EEC) who achieved complete remission after conservative treatment and to provide reference for clinical selection of appropriate conservative treatment.MethodThis retrospective cohort study included seven patients with EEC and 62 patients with AEH who underwent in vitro fertilization or intracytoplasmic sperm injection at the Reproductive Center of the Third Affiliated Hospital of Zhengzhou University between August 2015 and October 2023. The authors divided the participants into two groups based on the type of fertility‐sparing treatment received: the oral medication group and the levonorgestrel‐releasing intrauterine system (LNG‐IUS) group. The primary outcome was the cumulative clinical pregnancy rate. Secondary outcomes included clinical pregnancy rate per transfer cycle, embryo utilization rate, and high‐quality embryo rate.ResultsThe LNG‐IUS group had a significantly higher rate of usable embryos compared with the oral medication group (80.8% vs 91.1%, P = 0.005) and also had a thinner endometrial thickness on the day of embryo transfer. The cumulative clinical pregnancy rate was higher in the LNG‐IUS group compared with the medication group (46.7% vs 78.9%, P = 0.037), and the difference was statistically significant.ConclusionFor patients with AEH and EEC with fertility needs, the conservative treatment method of LNG‐IUS can achieve better assisted reproductive outcomes.

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Oral Progestin Treatment for Early-Stage Endometrial Cancer: A Systematic Review and Meta-analysis

Abstract: Based on the present systematic review and meta-analysis, oral progestin treatment is feasible and safe for patients of reproductive age.

Cited by 49 publications

References 48 publications

Efficacy of medroxyprogesterone acetate treatment and retreatment for atypical endometrial hyperplasia and endometrial cancer

Efficacy of medroxyprogesterone acetate treatment and retreatment for atypical endometrial hyperplasia and endometrial cancer

Fertility-Sparing Treatment in Young Patients With Grade 2 Presumed Stage IA Endometrioid Endometrial Adenocarcinoma

Analysis of assisted reproductive outcomes in patients with atypical endometrial hyperplasia and early‐stage endometrial cancer after fertility‐sparing treatment

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