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Original research
Retreatment with progestin for recurrence after complete response with fertility-sparing treatment in patients with endometrial cancer
  1. A Jin Lee1,
  2. Seung-Hyuk Shim1,
  3. Nae Ry Kim1,
  4. Eun Jung Yang1,
  5. Kyeong A So1,
  6. Sun Joo Lee1,
  7. Ji Young Lee1,
  8. Tae Jin Kim1 and
  9. Soon-Beom Kang2
  1. 1Department of Obstetrics and Gynecology, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea
  2. 2Hosan Women’s Hospital, Seoul, Republic of Korea
  1. Correspondence to Dr Seung-Hyuk Shim, Department of Obstetrics and Gynecology, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea; nastassja{at}hanmail.net

Abstract

Objective To assess the outcomes of retreatment using progestin for recurrence after a complete response with fertility-sparing treatment in patients with early endometrial cancer.

Methods We retrospectively reviewed the data of patients with presumed stage IA, grade 1 endometrioid endometrial cancer who developed intra-uterine recurrence after a complete response with fertility-sparing treatment using progestin. Oncological and pregnancy outcomes were analyzed after repeated fertility-sparing treatment. Logistic and Cox regression analyses were performed to analyze the prognostic factors associated with a complete response with secondary fertility-sparing treatment and recurrence-free survival after secondary fertility-sparing treatment, respectively.

Results Fifty patients with a median age of 31 years (range 23–40) underwent secondary fertility-sparing treatment. With a median secondary progestin treatment duration of 9 months (range 3–55), the complete response rate was 78% (39/50) and no patients had extra-uterine spread of disease. Among the 26 (67%) patients who attempted to conceive after complete response, 10 became pregnant (3 spontaneous abortions, 7 live births). Eighteen (46.1%) patients had a second recurrence, with a median recurrence-free survival after secondary fertility-sparing treatment of 14 months (range 3–36); 15 patients received tertiary fertility-sparing treatment and nine (60%) achieved a complete response. Polycystic ovary on ultrasound (OR 5.82, 95% CI 1.1 to 30.6, p=0.037) was associated with an increased complete response rate with secondary fertility-sparing treatment. Multivariable analysis revealed that recurrence-free survival after initial hormonal treatment >6 months (HR 0.11, 95% CI 0.02 to 0.51, p=0.005) and pregnancy after secondary fertility-sparing treatment (HR 0.27, 95% CI 0.08 to 0.98; p=0.047) were significantly associated with longer recurrence-free survival after secondary fertility-sparing treatment.

Conclusions Repeated progestin treatment was associated with a 78% response rate and it was safe in patients with intra-uterine recurrent endometrial cancer. Thus, it might help preserve fertility after first and second recurrences.

  • Endometrial Neoplasms

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/ijgc-2022-003546

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • Contributors AJL: Conceptualization, methodology, investigation, data curation, formal analysis, visualization, writing - original draft, writing - review and editing. S-HS: Conceptualization, investigation, methodology, formal analysis, resources, supervision, visualization, writing - original draft, writing - review and editing. NRK: Investigation, validation, writing - review and editing. EJY: Investigation, validation, writing - review and editing. KAS: Investigation, validation, writing - review and editing. SJL: Validation, writing - review and editing. JYL: Validation, writing - review and editing. TJK: Validation, writing - review and editing. S-BK: Data curation, resources, writing - review and editing. S-HS acts as guarantor.

    • Funding This work was supported by Konkuk University Medical Center Research Grant 2021.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.