Effects of a fertility-sparing re-treatment for recurrent atypical endometrial hyperplasia and endometrial cancer: a systematic literature review.

Abstract

OBJECTIVE:

To examine the effectiveness of progestin re-treatment for recurrent endometrial intraepithelial neoplasia (EIN), atypical endometrial hyperplasia (AH) and endometrial cancer (EC) following initial fertility-sparing treatment.

METHODS:

A comprehensive systematic review and meta-analysis were conducted by an Expert Panel of the Japan Society of Gynecologic Oncology Endometrial Cancer Committee. Multiple search engines, including PubMed/MEDLINE and the Cochrane Database, were searched in December 2021 using the keywords "Endometrial neoplasms," "Endometrial hyperplasia," "Endometrial intraepithelial neoplasia," "Fertility preservation," "Progestins," AND "Recurrence." Cases describing progestin re-treatment for recurrent EIN, AH and EC were compared with cases that underwent conventional hysterectomy. The primary outcomes were survival and disease recurrence, and the secondary outcome was pregnancy.

RESULTS:

After screening 238 studies, 32 with results for recurrent treatment were identified. These studies included 365 patients (270 received progestin re-treatment and 95 underwent hysterectomy). Most progestin re-treatment involved medroxyprogesterone acetate or megestrol acetate (94.5%). Complete remission (CR) following progestin re-treatment was achieved in 219 (81.1%) cases, with 3-, 6- and 9-month cumulative CR rates of 22.8%, 51.7% and 82.6%, respectively. Progestin re-treatment was associated with higher risk of disease recurrence than conventional hysterectomy was (odds ratio [OR]=6.78; 95% confidence interval [CI]=1.99-23.10), and one patient (0.4%) died of disease. Fifty-one (14.0%) women became pregnant after recurrence, and progestin re-treatment demonstrated a possibility of pregnancy (OR=2.48; 95% CI=0.94-6.58).

CONCLUSION:

This meta-analysis suggests that repeat progestin therapy is an effective option for women with recurrent EIN, AH and EC, who wish to retain their fertility.

• Authors: Isao Murakami, Hiroko Machida, Tohru Morisada, Yasuhisa Terao, Tsutomu Tabata, Mikio Mikami, Yasuyuki Hirashima, Yoichi Kobayashi, Tsukasa Baba, Satoru Nagase
• Journal: Journal of gynecologic oncology (J Gynecol Oncol) Vol. 34 Issue 4 Pg. e49 (07 2023) ISSN: 2005-0399 [Electronic] Korea (South)
• PMID: 36929578 (Publication Type: Systematic Review, Meta-Analysis, Journal Article)
• Copyright: © 2023. Asian Society of Gynecologic Oncology, Korean Society of Gynecologic Oncology, and Japan Society of Gynecologic Oncology.

Chemical References

• Progestins

Topics

• Pregnancy
• Female
• Humans
• Male
• Endometrial Hyperplasia (drug therapy)
• Progestins (therapeutic use)
• Retrospective Studies
• Neoplasm Recurrence, Local
• Endometrial Neoplasms (drug therapy)
• Fertility Preservation (methods)
• Treatment Outcome