Long-term oncologic outcomes after fertility-sparing management using oral progestin for young women with endometrial cancer (KGOG 2002)
Introduction
Endometrial cancer is the most common gynecologic cancer in Western countries1, 2 and the incidence in Eastern countries has been steadily increasing.3, 4, 5 About 2.9–14.4% of women with endometrial cancer are ⩽40 years of age, and cancer incidence in this age group is rising.6, 7 Most endometrial cancers in women of this age are early-stage, well-differentiated endometrioid adenocarcinomas8, 9; few show any evidence of myometrial invasion or lymph node metastasis.10, 11 Thus, such patients have a very high curative rate, and quality-of-life after treatment is an important consideration. Fertility preservation is one of the most important quality-of-life issues in women in this age range. Because the number of women who wish to have a first child at age 35–39 years is increasing, the number of women diagnosed with endometrial cancer during childbearing years, but prior to first conception, is rising, 12 as is the need for fertility-sparing management of such patients.
The most common type of fertility-sparing management involves progestin treatment via use of oral medroxyprogesterone acetate (MPA) or megestrol acetate (MA).13, 14, 15, 16 Young patients with well-differentiated endometrioid adenocarcinoma without myometrial invasion are considered to be good candidates for such management.13, 14, 15, 16 To date, however, only individual case reports and small case series on such patients have appeared except one phase 2 trial.17 Thus, long-term treatment outcomes have not been described. We therefore analysed the long-term oncologic outcomes of a large patient cohort treated using fertility-sparing management, employing oral progestin, and we also explored the factors associated with the failure of this treatment.
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Study population
We searched the records of eight tertiary cancer centers of Korea to gather data on young patients with endometrial cancer who were treated using fertility-sparing management employing oral progestin between January 1996 and June 2010. Inclusion criteria of this study included: (1) endometrioid type adenocarcinoma of endometrium, (2) well-differentiated tumor (grade 1); (3) presumed stage IA disease in terms of the 1988 International Federation of Obstetrics and Gynecology (FIGO) staging system
Patient’s characteristics
A total of 148 patients met the inclusion criteria and thus were included in the analysis. The mean age of patients was 31.3 years (range, 21–40 years). One hundred thirty-nine patients (93.9%) were nulliparous women. The characteristics of patients are shown in Table 1. All patients underwent transvaginal USG. As an additional imaging study, 122 patients (85%) underwent magnetic resonance imaging, and 33 patients (22%) underwent abdomino-pelvic CT, and 32 patients (22%) underwent PET or PET–CT.
Discussion
We found that fertility-sparing management using oral progestin in young women with FIGO stage IA, grade 1, endometrioid adenocarcinoma of the uterus resulted in CR rates of 77.7%. After achieving CR, recurrence rate was 30.4%. Therefore, 54.5% of patients who tried fertility-sparing management using oral progestin achieved durable CR, with median duration of 58 months (range, 14–151 months). Although the response rates in prior case reports and case series varied from 25–89%, the cited works
Source of funding
There was no financial support for this study.
Conflict of interest statement
None declared.
Acknowledgements
The authors thank Hee-Sug Ryu, MD, PhD (Department of Obstetrics and Gynecology, Ajou University Hospital, Suwon, Korea) and Seung Cheol Kim, MD, PhD (Department of Obstetrics and Gynecology, Ewha Womans University Mokdong Hospital, College of Medicine, Ewha Womans University, Seoul, Korea) for participating in this study. The authors also thank the Korean Gynecologic Oncology Group (KGOG) for supporting the work.
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