Reproductive and oncologic outcomes after progestin therapy for endometrial complex atypical hyperplasia or carcinoma

• Published in: American journal of obstetrics and gynecology Vol. 210; no. 3; pp. 255.e1 - 255.e4
• Main Authors: Kudesia, Rashmi, MD, Singer, Tomer, MD, Caputo, Thomas A., MD, Holcomb, Kevin Michael, MD, Kligman, Isaac, MD, Rosenwaks, Zev, MD, Gupta, Divya, MD
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01-03-2014
• Subjects: Adult; Antineoplastic Agents, Hormonal - therapeutic use; Carcinoma - drug therapy; endometrial cancer; endometrial hyperplasia; Endometrial Hyperplasia - drug therapy; Endometrial Neoplasms - drug therapy; Female; Fertility Preservation; fertility-sparing treatment; Humans; Intrauterine Devices, Medicated; Levonorgestrel - therapeutic use; Obstetrics and Gynecology; Pregnancy; Pregnancy Outcome; Progesterone - therapeutic use; progestin therapy; Retrospective Studies; Treatment Outcome; endometrial cancer; progestin therapy; endometrial hyperplasia; fertility-sparing treatment
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2013.11.001

Objectives This study evaluated fertility and oncological outcomes in women with complex atypical hyperplasia (CAH) or nonmyoinvasive grade 1 endometrioid endometrial carcinoma (EM) who desired fertility-sparing therapy. Study Design The retrospective cohort study included women younger than 45 years with CAH or EM who desired fertility-sparing treatment at our institution. Only patients for whom both oncological treatment and pregnancy outcomes were available were included. Statistical analyses were performed using a Fisher exact test, Pearson χ2 test, and Spearman rank correlation test, as appropriate. Results Seventy-five patients were identified, and 23 (13 CAH, 10 EM) met the inclusion criteria. All 23 patients had at least 1 prior pregnancy. Treatment was split between oral progesterone only (38.5% CAH, 40% EM), levonorgestrel intrauterine device only (30.8% CAH, 20% EM), and both (30.8% CAH, 40% EM). After a median follow-up of 13 months (range, 3–74 months), 9 patients (46.2% CAH, 30% EM, P  = .39) had persistent/progressive disease. Eight patients (30.8% CAH, 40% EM, P  = .69) ultimately had a hysterectomy, and 3 of these (13.0%) were found to have persistent/progressive disease. Median time from diagnosis to hysterectomy was 13 months (range, 4–56 months). Fourteen of the 23 patients utilized assisted reproductive techniques (60.9%); 12 underwent IVF and 2 chose a gestation carrier. Seven clinical intrauterine pregnancies (30.4%) resulting in 6 live births (26.1%) were found in the entire cohort. Conclusion Fertility-sparing treatment for CAH and grade 1 endometrial cancer is feasible with progestin therapy and leads to clinically meaningful rates of pregnancy in young women who desire fertility.