scholarly journals Maintenance Therapy Can Improve the Oncologic Prognosis and Obstetrical Outcome of Patients With Atypical Endometrial Hyperplasia and Endometrial Cancer After Fertility-Preserving Treatment: A Multicenter Retrospective Study

2021 ◽  
Vol 11 ◽  
Author(s):  
Yijiao He ◽  
Jianliu Wang ◽  
Yiqin Wang ◽  
Rong Zhou ◽  
Qun Lu ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Maintenance Therapy ◽  
Pregnancy Outcome ◽  
Recurrence Rate ◽  
Young Women ◽  
Endometrial Hyperplasia ◽  
Therapy Group ◽  
Complete Response ◽  
Reproductive Technology ◽  
Atypical Endometrial Hyperplasia

ObjectiveTo evaluate the effect of maintenance therapy for patients with atypical endometrial hyperplasia (AEH) and early endometrial cancer (EC) after successful fertility-preserving management on prognosis and pregnancy outcome.MethodsWe performed a retrospectively analysis of 109 young women with atypical endometrial hyperplasia and early endometrioid endometrial cancer who had received complete response after fertility-preserving treatment at 5centers between May 2005 and March 2021. Maintenance therapy regimes included low-dose oral progesterone, levonorgestrel intrauterine device(LNG-IUD) and combination oral contraceptive (COC). The patients were divided into two groups, maintenance therapy group and non-maintenance therapy group. Clinical characteristics, treatment regimens, prognosis, and pregnancy outcome were compared between the two groups.ResultsThe overall disease recurrence rate of the maintenance therapy group was significantly lower than that of the non-maintenance therapy group (P < 0.001). The recurrence rate of atypical endometrial hyperplasia and endometrial cancer in the maintenance therapy group were significantly lower than those in the non-maintenance group (P < 0.001). Maintenance therapy can reduce pregnancy rates and live birth rates. Maintenance therapy can protect the endometrium in patients treated with assisted reproductive technology (ART), greatly reducing the recurrence rate after ART (P<0.001).ConclusionMaintenance therapy plays a very important protective role in fertility-preserving treatment for patients with atypical endometrial hyperplasia and endometrial cancer, which could significantly reduce the risk of recurrence. It is recommended that patients could receive maintenance therapy as long as possible during the period from achieving complete response to pregnancy preparation if possible. It may provide recurrence-free survival long enough for childless young women to prepare for pregnancy in the future. It can also protect the endometrium of those who are preparing to use assisted reproductive technology, possibly by reducing the risk of recurrence by excessive stimulation with assisted reproductive drugs.

Fertility-Sparing Treatment of Early Endometrial Cancer and Complex Atypical Hyperplasia in Young Women of Childbearing Potential

2015 ◽  
Vol 25 (6) ◽  
pp. 1010-1014 ◽  
Author(s):  
Stanislav Mikhailovich Pronin ◽  
Olga Valerievna Novikova ◽  
Julia Yurievna Andreeva ◽  
Elena Grigorievna Novikova
Keyword(s):  
Endometrial Cancer ◽  
Young Women ◽  
Hormonal Therapy ◽  
Endometrial Hyperplasia ◽  
Endometrial Adenocarcinoma ◽  
Gonadotropin Releasing Hormone ◽  
Atypical Hyperplasia ◽  
Childbearing Potential ◽  
Atypical Endometrial Hyperplasia ◽  
Gonadotropin Releasing Hormone Agonist

ObjectiveTo evaluate oncologic and reproductive outcome with levonorgestrel-releasing intrauterine system combined with gonadotropin-releasing hormone agonist in women with grade 1 endometrial carcinoma, and the levonorgestrel monotherapy in women with complex atypical hyperplasia.Materials/MethodsA prospective study was conducted. We analyzed the clinical characteristics of 70 patients younger than 42 years (mean age, 33 years) with a diagnosis of complex atypical endometrial hyperplasia (AEH) or grade 1 endometrial adenocarcinoma who were treated with hormonal therapy at the Division of Gynecologic Oncology of P.A. Hertsen Moscow Cancer Research Institute from February 2009 to December 2012. Patients with complex AEH received monotherapy with levonorgestrel-releasing intrauterine system (Mirena, Shering, Finland; 52 mg). Patients with a diagnosis of grade 1 endometrial cancer were treated with levonorgestrel-releasing intrauterine system combined with gonadotropin-releasing hormone agonist (Zoladex; AstraZeneca UK Limited, UK; 3.6-mg depot). All the patients received hormonal therapy for a minimum of 6 months. Pretreatment evaluation consisted of transabdominal and transvaginal ultrasound in grayscale, color Doppler ultrasound, contrast-enhanced magnetic resonance imaging,cervical hysteroscopy, Pipelle endometrial biopsy, and morphological and immunohistochemical characteristics of the tissue.ResultsSeventy patients were included in study analyses. Twenty three (72%) of 32 patients with adenocarcinoma and 35 (92%) of 38 patients with AEH had complete remission, defined as the absence of any carcinoma or hyperplasia on endometrial sampling specimens. Among these cases, 2 patients with adenocarcinoma and 1 patient with AEH had recurrence after their complete response. Nine patients had persistent disease. Eight patients had 10 conceptions, resulting in 8 live births.ConclusionsThe suggested conservative treatment strategy can be considered as a valid therapeutic option for young women of childbearing potential with atypical endometrial hyperplasia and grade 1 endometrial adenocarcinoma who wish to preserve their fertility and thus may be recommended as an alternative to hysterectomy. Close follow-up during and after the treatment period is strictly required.

Impact of treatment duration in fertility-preserving management of endometrial cancer or atypical endometrial hyperplasia

2019 ◽  
Vol 29 (4) ◽  
pp. 699-704 ◽  
Author(s):  
Yiqin Wang ◽  
Rong Zhou ◽  
Haibo Wang ◽  
Huixin Liu ◽  
Jianliu Wang
Keyword(s):  
Endometrial Cancer ◽  
Pregnancy Rate ◽  
Treatment Duration ◽  
Endometrial Hyperplasia ◽  
Complete Response ◽  
Time Interval ◽  
Duration Of Treatment ◽  
Atypical Endometrial Hyperplasia ◽  
Fertility Sparing ◽  
Significant Difference

ObjectiveFertility preservation is an option for selected patients with endometrial hyperplasia or cancer. This study aimed to evaluate whether duration of treatment impacts the oncologic and reproductive outcomes.MethodsWe retrospectively reviewed patients diagnosed with endometrial cancer/atypical endometrial hyperplasia who underwent fertility-sparing treatment from January 2012 to December 2016. As the duration of treatment required by the patients was different, the patients who achieved a complete response were grouped according to the treatment duration as groups A (≤6 months), B (6–9 months), and C (>9 months).ResultsWith the prolongation of treatment duration from 6 months to 9 months to >9 months, the accumulative complete response rates for 67 patients were 58%, 76%, and 95.5%, respectively. Among groups A, B, and C there was no significant difference in the relapse rates (21.1%, 25%, and 36.4%, respectively, p=0.60) or the median time interval to relapse (14, 13, and 13.5 months, respectively, p=0.90). Maintenance treatment was an independent protective factor for recurrence (p=0.001), while the complication of diabetes was an independent risk factor for recurrence (p=0.03). Fertility rates (31%, 18.2%, and 62.5%, respectively, p=0.12) and the time interval to pregnancy (14, 13, and 8 months, respectively, p=0.67) were not significantly different among the three groups. Assisted reproductive technology was positively associated with a higher pregnancy rate (p=0.02) and a body mass index ≥25 kg/m2 was negatively associated with the pregnancy rate (p=0.047).ConclusionsLonger treatment duration was associated with higher rates of complete response. Longer treatment duration (>9 months) was not associated with a decrease in success rates of pregnancy.

Oncologic and obstetrical outcomes after fertility-preserving retreatment in patients with recurrent atypical endometrial hyperplasia and endometrial cancer

2020 ◽  
Vol 30 (12) ◽  
pp. 1902-1907
Author(s):  
Yijiao He ◽  
Yiqin Wang ◽  
Rong Zhou ◽  
Jianliu Wang
Keyword(s):  
Endometrial Cancer ◽  
Endometrial Hyperplasia ◽  
Response Rate ◽  
Complete Response ◽  
Successful Pregnancy ◽  
Atypical Endometrial Hyperplasia ◽  
Obstetrical Outcomes ◽  
Number Of Patients ◽  
Peking University

ObjectiveA number of patients with atypical endometrial hyperplasia and endometrial cancer have not yet given birth when they relapse after achieving complete response with initial fertility-preserving treatment. Often such patients still have a strong desire for fertility preservation; however, there are limited reports in the related literature on the efficacy of fertility-preserving retreatment in patients with relapse. This study intends to evaluate the safety and efficacy of fertility-preserving retreatment in patients with atypical endometrial hyperplasia and endometrial cancer after recurrence following initial fertility-preserving treatment.MethodsData from 110 patients with atypical endometrial hyperplasia and endometrial cancer who received fertility-preserving treatment in the Department of Obstetrics and Gynecology, Peking University People's Hospital (December 2005 to September 2019) were collected, and a retrospective analysis was performed on the clinical characteristics, histopathology results, and outcomes of 25 patients with recurrence.Results25 patients (9 with atypical endometrial hyperplasia and 16 with endometrial cancer) received fertility-preserving retreatment. After a median treatment duration of 5 months (range 3–18), 21 patients (84%, 21/25) achieved complete response and 4 patients (16%, 4/25) had a partial response. The median follow-up time was 19.5 months (range 8–76), and a total of 8 patients (38.1%, 8/21) relapsed. The time from retreatment to complete response for endometrial cancer was significantly longer than that for atypical endometrial hyperplasia (7.5 vs 3 months; p=0.007). Among the 21 patients who achieved complete response, 12 patients had a desire for fertility, among whom 8 patients had a successful pregnancy (66.7%, 8/12) and 6 patients experienced term birth (1 patient with natural pregnancy and 5 patients with assisted reproductive technology). Six patients (50%, 6/12) delivered 6 full-term babies.ConclusionThe response rate is high and obstetrical outcomes are favorable after fertility-preserving retreatment in patients with recurrence of atypical endometrial hyperplasia and endometrial cancer.

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