Efficacy of oral or intrauterine device-delivered progestin in patients with complex endometrial hyperplasia with atypia or early endometrial adenocarcinoma: A meta-analysis and systematic review of the literature

Baker, Jannah; Obermair, Andreas; Gebski, Val; Janda, Monika

doi:10.1016/j.ygyno.2011.11.043

Cited by 129 publications

(104 citation statements)

References 60 publications

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“…However, this was for inoperable cases caused by medical morbidity and not for fertility-sparing therapy [80]. According to a recent review, 17 of 37 patients with stage IA (without myometrial invasion), grade 1 endometrial cancer achieved a complete response with a progestin-containing intrauterine device with a pooled complete response rate of 46% (95% confidence interval, 29%-63%) [78], which is a somewhat disappointing outcome. Hence, some investigators have reported the outcomes of a combined use of progestincontaining intrauterine device with oral progestin [18] or gonadotropin-releasing hormone agonist [17] for fertilitysparing therapy to achieve better outcomes than either agent alone.…”

Section: Oncologic Outcomes After Progestin Therapymentioning

confidence: 99%

Progestins in the Fertility-Sparing Treatment and Retreatment of Patients With Primary and Recurrent Endometrial Cancer

Nam

2015

The Oncologist

109

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Endometrial cancer is the most common gynecologic cancer in developed countries. Approximately 3%-14% of endometrial cancers are diagnosed in young women under 40 who want to preserve their fertility. The incidence of endometrial cancer in this age group is increasing, for which fertility-sparing therapy is increasingly used because it is one of the most important quality of life issues in these women. Progestin therapy is the most common type of fertility-sparing therapy. In this review, the most up-to-date findings regarding fertility-sparing progestin therapy for young women with primary and recurrent endometrial cancer is addressed in terms of diagnosis, treatment, follow-up, and oncologic and reproductive outcomes. Fertility-sparing progestin therapy is highly effective in selected young women with primary and recurrent endometrial cancer. The selection of appropriate patients through comprehensive pretreatment evaluation is of paramount importance to achieve the best outcomes without compromising survival. Because of the high rate of recurrence after successful fertility-sparing therapy, close surveillance is mandatory, and prophylactic hysterectomy is the best option for patients who have completed family planning. Pregnancy outcomes are very promising with the aid of assisted reproductive technologies. Continuous daily oral medroxyprogesterone acetate and megestrol acetate are the preferred progestins for fertility-sparing therapy, but future studies should be performed to determine the optimal dose and treatment duration of these agents. The Oncologist 2015; 20:270-278 Implications for Practice: In young women with endometrial cancer, the cure rate is very high.Therefore, the efficacy of treatment should not be limited to the oncologic outcomes.The quality-of-life issue is as important as oncologic outcomes in these patients. Fertility preservation is one of the most important quality-of-life issues. Based on the results of numerous studies, fertility-sparing progestin therapy can be safely performed in endometrioid adenocarcinoma confined to the endometrium. It also can be reasonably recommended to selected women with more advanced disease and recurrent disease. However, careful follow-up is important because of the high rate of recurrence.

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Section: Oncologic Outcomes After Progestin Therapymentioning

confidence: 99%

Progestins in the Fertility-Sparing Treatment and Retreatment of Patients With Primary and Recurrent Endometrial Cancer

Nam

2015

The Oncologist

109

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“…A systematic review found a pooled regression rate of 90% for AH treated with LNG-IUS 14/20 μg levonorgestrel/24 hours and a dose-dependent increase in response rate when oral progestin was compared to LNG-IUS (26). Mean time taken to achieve complete response for patients with AH and early EC on different progestin therapy regimens was 5.9 months (range=1-12 months) in a meta-analysis (27). Whether the progestin dose delivered to the endometrium by the LNG-IUS Jaydess is too low to overcome high-risk endometrial hyperplasia or if the short duration of therapy (3-6 weeks) is explanatory for the low response rate in women with high-risk endometrial hyperplasia in our study remains to be clarified.…”

Section: Discussionmentioning

confidence: 99%

Low-dose LNG-IUS as Therapy for Endometrial Hyperplasia. A Prospective Cohort Pilot Study

Sletten

Arnes

Vereide

et al. 2018

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Abstract. Background/Aim: Progestin therapy has been accepted as therapy for low-and medium-risk endometrial hyperplasia. The aim of this study was to investigate the efficacy of the low-dose levonorgestrel-impregnated intrauterine system (LNG-IUS) 13.5 mg (JaydessEndometrial carcinoma (EC) is presently the most frequent genital malignancy in women, showing a constant rise all over the Western world (1, 2). Endometrial hyperplasia, the preliminary stage of EC, undergoes malignant transformation in up to 29% of cases if left untreated (3). Women with atypical endometrial hyperplasia (AH), have been proven to have the highest risk of co-existent or future EC, have routinely been treated by hysterectomy (3-6). In contrast, conservative management with progestin therapy has been used in clinical practice for women with non-atypical endometrial hyperplasia (low-and medium risk), although consensus regarding optimal progestin agent, dose and therapy duration has never been established.During the recent decades the levonorgestrel-impregnated intrauterine system (LNG-IUS) has been introduced as an alternative to oral therapy for endometrial hyperplasia and cohort studies as well as case reports have shown promising results (7-12). The endometrial mucosal progestin concentration observed in LNG-IUS 63 mg users has been measured hundred-fold higher than in oral progestin users (13). A recent randomized national multicentre study comparing the high-dose LNG-IUS 52 mg (Mirena ® , Bayer Pharmaceuticals, Berlin, Germany) with oral progestin as therapy for low-and medium risk endometrial hyperplasia, reported 100% therapy response for LNG-IUS Mirena after 6 months therapy duration (14). Lower response rates were found for cyclic (67%) and continuous (96%) oral progestin (14).In selected cases progestin therapy has also been recommended for women with AH (high-risk). It has also been considered as an option for women desiring fertility preservation and for non-ideal surgical candidates. Recent results have demonstrated resolution of high-risk endometrial hyperplasia in 66%-85.6% after use of progestin therapy, intrauterine therapy being superior to oral administration (15)(16)(17). However, the ideal mucosal concentration of progestin for reversal of low-and medium versus high-risk endometrial hyperplasia is still unknown.

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“…Post-treatment sampling of the endometrium reveals CAH regression in up to 100% of cases, and carcinoma regression in up to 70%. 10 Because of atrophy that is induced by progestin, sampling may be difficult. In the current case, a resectoscope was used to obtain tissue after initial therapy.…”

Section: Discussionmentioning

confidence: 99%

Fertility-sparing treatment in a young patient with complex atypical hyperplasia of the endometrium

Toit

2014

Southern African Journal of Gynaecological Oncology

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Efficacy of oral or intrauterine device-delivered progestin in patients with complex endometrial hyperplasia with atypia or early endometrial adenocarcinoma: A meta-analysis and systematic review of the literature

Cited by 129 publications

References 60 publications

Progestins in the Fertility-Sparing Treatment and Retreatment of Patients With Primary and Recurrent Endometrial Cancer

Progestins in the Fertility-Sparing Treatment and Retreatment of Patients With Primary and Recurrent Endometrial Cancer

Low-dose LNG-IUS as Therapy for Endometrial Hyperplasia. A Prospective Cohort Pilot Study

Fertility-sparing treatment in a young patient with complex atypical hyperplasia of the endometrium

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