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

Park, Jeong-Yeol; Lee, Sang-Hun; Seong, Seok Ju; Kim, Dae-Yeon; Kim, Tae-Jin; Kim, Jae Weon; Kim, Jong-Hyeok; Kim, Yong‐Man; Kim, Young‐Tak; Bae, Duk-Soo; Nam, Joo‐Hyun

doi:10.1016/j.ygyno.2012.12.037

Cited by 80 publications

(56 citation statements)

References 18 publications

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“…However, the treatment outcomes are not well known in such cases, and few studies have addressed this as a part of their wider analyses (Table 3) Fertility-Sparing Management for Endometrial Cancer CME findings for the largest endometrial cancer series yet analyzed regarding this subject. Of 33 patients with recurrent endometrial cancer in that study who received a second round of fertility-sparing progestin therapy, a complete response rate of 89% and rerecurrence rate of 42% were recorded, with no disease progression [13]. These outcomes were similar to those of the primary fertility-sparing progestin therapy.…”

Section: Progestin Therapy For Recurrent Diseasementioning

confidence: 68%

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

Nam

2015

The Oncologist

Self Cite

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: Progestin Therapy For Recurrent Diseasementioning

confidence: 68%

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

Nam

2015

The Oncologist

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109

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“…After a follow-up of 51 months, none of the patient had died of disease. 41 Recommendation: In case of recurrent disease in initial complete responders re-treatment with progestins seems to be efficient and hence can be offered.…”

Section: Recurrencementioning

confidence: 99%

European Society of Gynecological Oncology Task Force for Fertility Preservation

Rodolakis

Biliatis

Morice

et al. 2015

International Journal of Gynecological Cancer

150

171

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Endometrial cancer (EC) in young women of reproductive age is a relatively rare diagnosis. However, since in the modern era women delay their childbearing for a variety of social reasons, more and more women in the near future will be nulliparous and have a diagnosis of EC at the same time. Hence, a more conservative approach of EC is desirable to preserve fertility of these women, without compromising their survival. Recently, the number of studies reporting encouraging results on fertility-sparing management of EC with high dose of progestins is increasing. It seems that preserving the uterus and the ovaries in a carefully selected patient with EC confers only a very small risk combined with an enormous benefit. Selection of women suitable for such a conservative approach, as well as method of treatment, follow-up, recurrence, obstetric outcomes, and survival rates are very important parameters when consulting women with EC wishing to preserve their fertility. In this article, we try to elucidate all the previously mentioned aspects and formulate clinical recommendations, based on published data, about the most proper approach and consultation of these patients.

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“…Further response with therapy prolongation up to 9 to 12 months and 70%Y85% complete response after second-round treatment have been reported, suggesting conservative re-treatment may be feasible and safe, albeit a temporary approach, for women who decline definitive surgery at the time of uterine-confined persistence or recurrence. 7,15,37,38 In the present series, 2 patients experienced a persistence of disease, of whom 1 refused definitive surgery and was successfully re-treated with combined HR and LNG-IUD.…”

Section: Discussionmentioning

confidence: 65%

Long-Term Oncologic and Reproductive Outcomes in Young Women With Early Endometrial Cancer Conservatively Treated

Laurelli¹,

Falcone²,

Gallo³

et al. 2016

International Journal of Gynecological Cancer

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

Cited by 80 publications

References 18 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

European Society of Gynecological Oncology Task Force for Fertility Preservation

Long-Term Oncologic and Reproductive Outcomes in Young Women With Early Endometrial Cancer Conservatively Treated

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