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. 2012 May;3(5):1002-1006.
doi: 10.3892/ol.2012.602. Epub 2012 Feb 10.

Fertility-sparing treatment using medroxyprogesterone acetate for endometrial carcinoma

Hiroyuki Fujiwara  1 , Toshiko Jobo, Yuji Takei, Yasushi Saga, Manami Imai, Tsutomu Arai, Akiyo Taneichi, Shizuo Machida, Yoshifumi Takahashi, Mitsuaki Suzuki
Affiliations

Fertility-sparing treatment using medroxyprogesterone acetate for endometrial carcinoma

Hiroyuki Fujiwara et al. Oncol Lett. 2012 May.

Abstract

The purpose of this study was to present the results of fertility-sparing treatment using medroxyprogesterone acetate (MPA) for endometrial carcinoma (EC), and to clarify patient characteristics by investigating patient background factors. A total of 59 patients with EC, who received MPA as fertility-sparing therapy at two institutions over a 21-year period between 1987 and 2008, were studied retrospectively. Patients were administered oral MPA at 400-600 mg/day for 16-24 weeks as long as they responded. Endometrial tissue was assessed twice, at 8-12 weeks (during treatment) and shortly after treatment. The overall complete response (CR) rate was 71%. A total of 22 (52%) of 42 responders later developed relapse. A total of 19 cases became pregnant, and 25 infants were born. Eighty percent of recurrences occurred within 2 years. For stages I a and I b- II a (FIGO, 1988), initial CR rates were 80.0 and 42.9%, respectively (p<0.01), demonstrating a significant difference. Total hysterectomy was performed for 26 patients (44%) due to recurrence or failure to respond to the initial treatment. Among these 26 patients, postoperative stages were more advanced in 10 patients (38%). The grade advanced (became more poorly differentiated) postoperatively in 2 patients (8%). Premenopausal females with EC can be treated successfully with MPA, however patients should be informed of the risks and limitations of this conservative treatment.

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Figures

Figure 1
Figure 1
Therapeutic results of fertility-sparing treatment using MPA. MPA, medroxyprogesterone acetate; CR, complete response; PR, partial response; NC, no change; TAH, total abdominal hysterectomy.
Figure 2
Figure 2
Recurrence-free survival curve and timing of recurrence (Kaplan-Meier analysis).
Figure 3
Figure 3
Initial CR rate and rate of recurrence following CR in relation to clinical stage. CR, complete response.
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