Oncologic and obstetrical outcomes after fertility-preserving retreatment in patients with recurrent atypical endometrial hyperplasia and endometrial cancer

Abstract

ObjectiveA number of patients with atypical endometrial hyperplasia and endometrial cancer have not yet given birth when they relapse after achieving complete response with initial fertility-preserving treatment. Often such patients still have a strong desire for fertility preservation; however, there are limited reports in the related literature on the efficacy of fertility-preserving retreatment in patients with relapse. This study intends to evaluate the safety and efficacy of fertility-preserving retreatment in patients with atypical endometrial hyperplasia and endometrial cancer after recurrence following initial fertility-preserving treatment.MethodsData from 110 patients with atypical endometrial hyperplasia and endometrial cancer who received fertility-preserving treatment in the Department of Obstetrics and Gynecology, Peking University People's Hospital (December 2005 to September 2019) were collected, and a retrospective analysis was performed on the clinical characteristics, histopathology results, and outcomes of 25 patients with recurrence.Results25 patients (9 with atypical endometrial hyperplasia and 16 with endometrial cancer) received fertility-preserving retreatment. After a median treatment duration of 5 months (range 3–18), 21 patients (84%, 21/25) achieved complete response and 4 patients (16%, 4/25) had a partial response. The median follow-up time was 19.5 months (range 8–76), and a total of 8 patients (38.1%, 8/21) relapsed. The time from retreatment to complete response for endometrial cancer was significantly longer than that for atypical endometrial hyperplasia (7.5 vs 3 months; p=0.007). Among the 21 patients who achieved complete response, 12 patients had a desire for fertility, among whom 8 patients had a successful pregnancy (66.7%, 8/12) and 6 patients experienced term birth (1 patient with natural pregnancy and 5 patients with assisted reproductive technology). Six patients (50%, 6/12) delivered 6 full-term babies.ConclusionThe response rate is high and obstetrical outcomes are favorable after fertility-preserving retreatment in patients with recurrence of atypical endometrial hyperplasia and endometrial cancer.

Retreatment with progestin for recurrence after complete response with fertility-sparing treatment in patients with endometrial cancer

“…Limited studies have assessed oncological outcomes of repeated hormone treatment in patients with endometrial cancer with relapse after fertility-sparing treatment (see Online supplemental table S3). 17 18 21–24 According to these studies, the complete response rate with secondary fertility-sparing treatment ranges from 76% to 98% for recurrent disease, and the complete response rate was 78% (39/50) after secondary fertility-sparing treatment in our study, consistent with the results of previous studies 17 18 21–24. In a multicenter study,17 six pregnancies, including all live births, were reported in five patients after achieving a complete response after recurrence.…”

“…Chen et al reported a complete response rate of 70% with tertiary fertility-sparing treatment in 10 patients with a second recurrence 22. In another study,24 two patients achieved a complete response (66%, 2/3) with tertiary fertility-sparing treatment. In our study, 15 patients with a second intra-uterine recurrence underwent tertiary fertility-sparing treatment.…”

Multiple attempts at fertility preservation in atypical endometrial hyperplasia and early endometrial cancer

“…Of note, the time from the initial complete response to recurrence was shorter than the time from the second complete response to re-recurrence. 6 …”

“…Although research on re-treatment outcomes is limited, complete response rates cited in the literature are encouraging, approaching 80–90% in recent studies. 5 6 In the case of this patient, she was counseled on re-treatment and she elected for an additional cycle of fertility-sparing therapy. Re-treatment options are similar to initial treatment options, although further consideration can be given to combined therapies based on the patient’s clinical course, adverse effects, or risk factors.…”

Maintenance Therapy Can Improve the Oncologic Prognosis and Obstetrical Outcome of Patients With Atypical Endometrial Hyperplasia and Endometrial Cancer After Fertility-Preserving Treatment: A Multicenter Retrospective Study

“…However, the recurrence rates are still relatively high (20-50%) (4)(5)(6) according to the literature. The median time from achieving complete response to the first recurrence is 14 months (7). This predicts that many patients may face recurrence if they fail to conceive within the median time to recurrence.…”