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Efficacies and pregnant outcomes of fertility-sparing treatment with medroxyprogesterone acetate for endometrioid adenocarcinoma and complex atypical hyperplasia: our experience and a review of the literature

  • Gynecologic Oncology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

We retrospectively analyzed oncologic and reproductive outcomes of fertility-seeking premenopausal women with complex atypical hyperplasia (CAH) or Grade 1 endometrial adenocarcinoma (G1EA) who underwent medical management with high-dose medroxyprogesterone acetate (MPA) therapy.

Methods

Patients were given a dose of 400–600 mg of MPA orally on a daily basis. They had histologically confirmed CAH or G1EA at presumed stage IA and wished to preserve fertility. Endometrial tissue sampling was carried out by dilation and curettage before and after the treatment and the pathologic response to MPA treatment was assessed.

Results

A total of 27 premenopausal patients received MPA therapy. The median follow-up time was 39.2 months (3.4–153.8 months). Complete response was achieved in 81.8 % (9/11) of CAH cases and 68.8 % (11/16) of G1EA. Although no recurrences were found in CAH patients, nine G1EA patients (81.8 %) eventually recurred and underwent total hysterectomy. Neither therapeutic death nor irreversible toxicities were observed during the follow-up periods. Five patients (4 CAH and 1 G1EA) became pregnant and had nine live births.

Conclusion

The high efficacy of fertility-sparing treatment with MPA was shown demonstrated. MPA therapy can be considered acceptable for the purpose of enabling patients to preserve their fertility. However, the rate of recurrence was high in patients with G1EA. Even in responders, close follow-up is required and a total hysterectomy needs to be considered without delay. Patients should be aware of the risks and limitations of this conservative treatment.

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Acknowledgments

We thank Yuko Nishimura for her secretarial assistance and Yuri Matsumoto for her statistical advices.

Conflict of interest

The authors declare that they have no conflicts of interest in the research.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2, Yamadaoka Suita, Osaka, 5650871, Japan

    Chifumi Ohyagi-Hara, Kenjiro Sawada, Isobe Aki, Seiji Mabuchi, Eiji Kobayashi, Yutaka Ueda, Kiyoshi Yoshino, Masami Fujita, Tateki Tsutsui & Tadashi Kimura

  2. Department of Obstetrics and Gynecology, JCHO Osaka Hospital, 4-2-78, Fukushima, Osaka, 5530003, Japan

    Chifumi Ohyagi-Hara & Tateki Tsutsui

Authors
  1. Chifumi Ohyagi-Hara
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  2. Kenjiro Sawada
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  3. Isobe Aki
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  4. Seiji Mabuchi
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  7. Kiyoshi Yoshino
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  10. Tadashi Kimura
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Correspondence to Kenjiro Sawada.

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Ohyagi-Hara, C., Sawada, K., Aki, I. et al. Efficacies and pregnant outcomes of fertility-sparing treatment with medroxyprogesterone acetate for endometrioid adenocarcinoma and complex atypical hyperplasia: our experience and a review of the literature. Arch Gynecol Obstet 291, 151–157 (2015). https://doi.org/10.1007/s00404-014-3417-z

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  • DOI: https://doi.org/10.1007/s00404-014-3417-z

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