Progestin re-treatment in patients with recurrent endometrial adenocarcinoma after successful fertility-sparing management using progestin

Jeong‐Yeol Park, Sang‐Hun Lee, Seok Ju Seong, Dae‐Yeon Kim, Tae‐Jin Kim, Jae‐Weon Kim, Jong-Hyeok Kim, Yong‐Man Kim, Young‐Tak Kim, Duk‐Soo Bae, Joo‐Hyun Nam
In: Gynecologic Oncology · 2012 · vol. 129(1) , pp. 7–11 · doi:10.1016/j.ygyno.2012.12.037 · PMID:23283299 · W2021542768
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This study investigated the efficacy and safety of re-administering progestin therapy in patients who experienced recurrent endometrial adenocarcinoma after initial successful fertility-sparing management with progestin.

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Abstract

ObjectiveTo analyze the outcomes of second round of fertility-sparing management using progestin in patients with recurrent endometrial cancer after successful fertility-sparing management using progestin.MethodsWe reviewed 45 patients who had recurrence after achieving complete remission by fertility-sparing management using progestin for presumed stage IA, grade 1, endometrioid adenocarcinoma of the uterus. Of 45 patients, 33 tried progestin re-treatment at recurrence and were included in this study.ResultsRecurrent disease was atypical hyperplasia in 13 patients (39%) and grade 1 endometrioid adenocarcinoma in 20 patients (61%) which were confined to the endometrium. Thirty patients (91%) received medroxyprogesterone acetate (dose range, 80-500 mg/day) and three patients (9%) received megestrol acetate (dose range, 80-160 mg/day), with 29 patients receiving a dose of 500 mg/day of medroxyprogesterone acetate. The median duration of treatment was 6 months (range, 3-19 months). Five patients failed to respond to progestin re-treatment and underwent definitive surgical treatment including hysterectomy. Twenty eight patients (85%) showed complete response to progestin re-treatment. The median follow-up time after progestin re-treatment in 28 patients who achieved complete remission was 51 months (range, 24-160 months). During follow-up, five patients had second recurrence after median time interval of 14 months (range, 4-82 months). All patients who tried progestin re-treatment are alive without evidence of disease.ConclusionProgestin re-treatment in patients with recurrent endometrial cancer was effective and safe. Therefore, this can be recommended for young women who still want to preserve fertility at recurrence after complete response to progestin.

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