Is repeated high-dose medroxyprogesterone acetate (MPA) therapy permissible for patients with early stage endometrial cancer or atypical endometrial hyperplasia who desire preserving fertility?.
- Author:
Wataru YAMAGAMI
1
;
Nobuyuki SUSUMU
;
Takeshi MAKABE
;
Kensuke SAKAI
;
Hiroyuki NOMURA
;
Fumio KATAOKA
;
Akira HIRASAWA
;
Kouji BANNO
;
Daisuke AOKI
Author Information
- Publication Type:Original Article
- Keywords: Endometrial Neoplasms; Endometrial Hyperplasia; Hormone Replacement Therapy; Fertility Preservation; Intrauterine Recurrence
- MeSH: Carcinoma, Endometrioid; Endometrial Hyperplasia*; Endometrial Neoplasms*; Female; Fertility Preservation; Fertility*; Hormone Replacement Therapy; Humans; Medical Records; Medroxyprogesterone Acetate*; Medroxyprogesterone*; Pregnancy Rate; Recurrence
- From:Journal of Gynecologic Oncology 2018;29(2):e21-
- CountryRepublic of Korea
- Language:English
- Abstract: OBJECTIVE: Reports on the repeated administration of medroxyprogesterone acetate (MPA) for intrauterine recurrence after fertility-preserving therapy for atypical endometrial hyperplasia (AEH) and early grade 1 endometrioid carcinoma (G1) are lacking. We aimed to clarify the outcomes of repeated MPA therapy in cases of intrauterine recurrence after fertility-preserving therapy with MPA against AEH/early G1. METHODS: Patients with AEH or stage IA well-differentiated endometrioid carcinoma without myometrial invasion who underwent first-line MPA therapy for primary lesions or intrauterine recurrence were divided into initial treatment and repeated treatment groups (162 and 82 patients, respectively). Oral MPA administration (400−600 mg/day) was continued until pathological tumor disappearance. Data regarding clinicopathological factors, adverse events, and outcomes following the initial and repeated hormonal treatments were extracted from medical records and analyzed. RESULTS: Complete response rates in the initial and repeated treatment groups were 98.5% and 96.4%, respectively, among patients with AEH, and were 90.7% and 98.1%, respectively, among patients with G1. In the initial treatment group, 5-year recurrence-free survival (RFS) rates were 53.7% and 33.2% among patients with AEH and G1, respectively. In the repeated treatment group, RFS rates were 14.0% and 11.2% among patients with AEH and G1, respectively. Among patients with AEH, the pregnancy rate tended to be lower in the repeated treatment group than in the initial treatment group (11.1% vs. 29.2%; p=0.107), while no significant group difference was observed among patients with G1 (20.8% vs. 22.7%). CONCLUSION: Repeated treatment is sufficiently effective for intrauterine recurrence after hormonal therapy for AEH/early G1.
