Long-term outcomes of fertility-sparing treatment of atypical polypoid adenomyoma with medroxyprogesterone acetate

Nomura, Hidetaka; Sugiyama, Yuko; Tanigawa, Terumi; Matoda, Maki; Kanao, Hiroyuki; Kondo, Eiji; Takeshima, Nobuhiro

doi:10.1007/s00404-015-3824-9

Cited by 24 publications

(47 citation statements)

References 16 publications

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“…Medical treatment by using medroxyprogesterone acetate was proposed by Nomura et al (2015) in 18 patients (13 patients with APA, 4 patient with APA coexisting with endometrial adenocarcinoma, 1 patient with APA coexisting with atypical endometrial hyperplasia) diagnosed after dilatation and curettage. On 18 patients studied, 14 achieved a partial or complete response, 8 had a recurrence, 10 eventually underwent hysterectomy, 9 developed endometrial cancer.…”

Section: Discussionmentioning

confidence: 99%

“…Although APA is considered a benign disease, it may recur, furthermore it is reported a frequent APA coexistence with endometrioid adenocarcinoma of the endometrium or with atypical endometrial hyperplasia and the possibility of APA progression to endometrioid adenocarcinoma of the endometrium (Yamagami et al, 2015, Inoue et al, 2014, Nomura et al, 2015). …”

Section: Introductionmentioning

confidence: 99%

“…In post-menopause hysterectomy is the treatment of choice, while in patients who may want to preserve the fertility potential a conservative surgical procedure has been suggested (Matsumoto et al, 2013, Yamagami et al, 2015, Nomura et al, 2015, Di Spiezio Sardo et al, 2008). …”

Section: Introductionmentioning

confidence: 99%

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Recurrent atypical polypoid adenomyoma and pregnancy: A new conservative approach with levonorgestrel-releasing intrauterine system

Solima

Liprandi

Belloni

et al. 2017

Gynecologic Oncology Reports

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Recurrent atypical polypoid adenomyoma and pregnancy: A new conservative approach with levonorgestrel-releasing intrauterine system

Solima

Liprandi

Belloni

et al. 2017

Gynecologic Oncology Reports

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“…Since APA was considered a hormone-related tumor (15), hormonal therapy was suggested as a potential treatment option. Although we reported a high sensitivity (77.8%) of MPA for APA, the recurrence rate was high (12). Therefore, we focused on maintenance hormonal therapy.…”

Section: Discussionmentioning

confidence: 99%

“…We believe that treatment with progestin may be a good option, since it is used for endometrial cancer and atypical endometrial hyperplasia. We have previously reported the efficacy of treatment of these patients with medroxyprogesterone acetate (MPA) (12,13). Although a high response rate (77.8%) was obtained with MPA, the recurrence rate was also high.…”

Section: Introductionmentioning

confidence: 99%

Maintenance hormonal therapy after treatment with medroxyprogesterone acetate for patients with atypical polypoid adenomyoma

Nomura

Sugiyama

Tanigawa

et al. 2018

Japanese Journal of Clinical Oncology

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Background: As atypical polypoid adenomyoma (APA) has been reported to be a hormone-related tumor, we aimed to analyze the efficacy and safety of maintenance hormonal therapy after fertility-preserving treatment of these patients with medroxyprogesterone acetate (MPA). Methods: Data were retrospectively analyzed from patients with APA who were treated with a fertility-preserving regimen including MPA between October 2001 and December 2011. Eighteen patients were treated with MPA and 14 (77.8%) achieved either a complete or a partial response after the planned treatment. Five patients took progestin for maintenance therapy. Results: Eighteen patients were treated for a mean observation period of 96.7 months. While taking the maintenance therapy, no patient had APA relapse. One patient developed welldifferentiated endometrioid adenocarcinoma 18 months after she stopped taking maintenance progestin. Eleven patients without maintenance therapy underwent hysterectomy, andnine of them developed well-differentiated endometrial cancer. Through univariate analysis, there was a significant difference in time to hysterectomy between patients with and without maintenance therapy (P = 0.015). Through multivariate analysis, body mass index (BMI), menstrual status before protocol therapy, maintenance treatment, and pregnancy were found to be significantly associated with a lower risk of hysterectomy. No patient had a recurrence of APA after hysterectomy during the observation period (median, 54 months; range, 2-148 months). Conclusion: No patient showed progression while receiving hormonal therapy, including initial protocol therapy. Maintenance hormonal therapy after treatment with MPA was highly effective and safe, particularly in patients with BMI ≧24 kg/m 2 and irregular menstruation cycle.

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Oncologic outcomes of conservative treatment of atypical polypoid adenomyoma of the uterus: A two‐center experience

Casadio

Raffone

Travaglino

et al. 2022

Intl J Gynecology & Obste

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Objective Atypical polypoid adenomyoma (APA) is a rare uterine premalignant lesion mainly occurring in premenopausal and nulliparous women. Although hysteroscopic resection (HR) has showed promising results, the conservative management of APA in young women is not standardized, and few data are available in the literature. We aimed to assess oncologic outcomes of the conservative treatment of APA. Methods A multicenter observational retrospective cohort study was performed including all patients with APA who underwent conservative treatment from January 2006 to June 2020. Rates of each oncologic outcome (i.e. initial complete response, persistence, progression to cancer, recurrence, long‐term treatment success, and treatment failure) were calculated for all conservative treatment together and separately. Results Twenty‐five patients were included. Conservative treatments consisted of HR alone (n = 14) and HR + progestin (n = 11). Overall, 24 (96%) patients showed initial complete response, of which 21 (84%) showed long‐term treatment success; four (16%) patients had progression to cancer, of which two (8%) first recurred as APA. Long‐term treatment success was achieved in 13 of 14 (92.9%) patients with HR alone and 8 of 11 (72.3%) with HR + progestin. Conclusion Conservative treatment appears to be a safe option in women with APA. The four‐steps HR might be considered as the first‐line conservative approach, while the addition of progestin does not seem to improve oncologic outcomes. However, the risk of progression to cancer highlights the need for a close and long‐term follow up with ultrasonography and hysteroscopic biopsies, and for hysterectomy in patients not desiring pregnancy.

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Long-term outcomes of fertility-sparing treatment of atypical polypoid adenomyoma with medroxyprogesterone acetate

Cited by 24 publications

References 16 publications

Recurrent atypical polypoid adenomyoma and pregnancy: A new conservative approach with levonorgestrel-releasing intrauterine system

Recurrent atypical polypoid adenomyoma and pregnancy: A new conservative approach with levonorgestrel-releasing intrauterine system

Maintenance hormonal therapy after treatment with medroxyprogesterone acetate for patients with atypical polypoid adenomyoma

Oncologic outcomes of conservative treatment of atypical polypoid adenomyoma of the uterus: A two‐center experience

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