Andrea N Simpson1, Tomer Feigenberg2, Blaise A Clarke3, Lilian T Gien4, Nadia Ismiil5, Stephane Laframboise6, Christine Massey7, Sarah E Ferguson8. 1. Department of Obstetrics & Gynecology, University of Toronto, Division of Gynecologic Oncology, Princess Margaret Hospital/University Health Network, 610 University Ave M 700, Toronto, Ontario M5G 2M9, Canada. Electronic address: andrea.simpson@utoronto.ca. 2. Department of Obstetrics & Gynecology, University of Toronto, Division of Gynecologic Oncology, Princess Margaret Hospital/University Health Network, 610 University Ave M 700, Toronto, Ontario M5G 2M9, Canada. Electronic address: tomer.feigenberg@trilliumhealthpartners.ca. 3. Department of Pathology and Laboratory Medicine, Toronto General Hospital/University Health Network, 11th Floor Eaton Wing, 200 Elizabeth St, Toronto, Ontario M5G 2C4, Canada. Electronic address: blaise.clarke@uhn.ca. 4. Department of Obstetrics & Gynecology, University of Toronto, Division of Gynecologic Oncology, Sunnybrook Health Sciences Centre, Odette Cancer Centre, T2-104, 2075 Bayview Ave, Toronto, Ontario M4N 3M5, Canada. Electronic address: lilian.gien@sunnybrook.ca. 5. Department of Pathology and Laboratory Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, Ontario M4N 3M5, Canada. Electronic address: nadia.ismiil@sunnybrook.ca. 6. Department of Obstetrics & Gynecology, University of Toronto, Division of Gynecologic Oncology, Princess Margaret Hospital/University Health Network, 610 University Ave M 700, Toronto, Ontario M5G 2M9, Canada. Electronic address: stephane.laframbroise@uhn.ca. 7. Independent Biostatistician, 93 George St. South, Ste 221, Brampton, Ontario L6Y 1P4, Canada. Electronic address: cmssyc@gmail.com. 8. Department of Obstetrics & Gynecology, University of Toronto, Division of Gynecologic Oncology, Princess Margaret Hospital/University Health Network, 610 University Ave M 700, Toronto, Ontario M5G 2M9, Canada. Electronic address: sarah.ferguson@uhn.ca.
Abstract
OBJECTIVE: Oral progestin is an alternative to hysterectomy for women with complex atypical hyperplasia (CAH) or grade one endometrial cancer (G1EC) who wish fertility preservation. We evaluated treatment efficacy and fertility outcomes in this population. METHODS: Women <45 y treated with oral progestin for CAH or G1EC were identified from two cancer centers. Data were obtained from medical records and telephone questionnaires. Time until complete response (CR), and from CR until recurrence was censored for patients without events and analyzed for associations with patient and treatment characteristics; cumulative incidence functions were used to estimate event probability over time. RESULTS: 44 patients were identified, 19 (43%) with CAH and 25 (57%) with G1EC. Median age was 36.5 y (26-44). 24 (55%) achieved CR (median time: 5.7 months). Older age was associated with a lower likelihood of CR (HR 0.84, p=0.0003, 95% CI, 0.8-0.9). CR probability appeared to plateau after 12 months of therapy. Among those with CR, 13 (54%) recurred (median time 3.5 y). 24 patients (55%) underwent hysterectomy; 3 (13%) were upstaged. 11 (25%) underwent fertility treatment with the following outcomes: 6 (55%) no pregnancy, 2 (18%) at least one live infant, and 3 (27%) spontaneous abortion. One achieved a live birth without intervention. CONCLUSION: Oral progestin is an effective temporizing fertility-sparing treatment for women with CAH/G1EC. Fertility specialist involvement is recommended due to the low live birth rate without intervention. Progestin therapy should be re-evaluated at 1 year in non-responders due to a low probability of success. Hysterectomy is recommended after childbearing due to a high recurrence rate.
OBJECTIVE: Oral progestin is an alternative to hysterectomy for women with complex atypical hyperplasia (CAH) or grade one endometrial cancer (G1EC) who wish fertility preservation. We evaluated treatment efficacy and fertility outcomes in this population. METHODS:Women <45 y treated with oral progestin for CAH or G1EC were identified from two cancer centers. Data were obtained from medical records and telephone questionnaires. Time until complete response (CR), and from CR until recurrence was censored for patients without events and analyzed for associations with patient and treatment characteristics; cumulative incidence functions were used to estimate event probability over time. RESULTS: 44 patients were identified, 19 (43%) with CAH and 25 (57%) with G1EC. Median age was 36.5 y (26-44). 24 (55%) achieved CR (median time: 5.7 months). Older age was associated with a lower likelihood of CR (HR 0.84, p=0.0003, 95% CI, 0.8-0.9). CR probability appeared to plateau after 12 months of therapy. Among those with CR, 13 (54%) recurred (median time 3.5 y). 24 patients (55%) underwent hysterectomy; 3 (13%) were upstaged. 11 (25%) underwent fertility treatment with the following outcomes: 6 (55%) no pregnancy, 2 (18%) at least one live infant, and 3 (27%) spontaneous abortion. One achieved a live birth without intervention. CONCLUSION: Oral progestin is an effective temporizing fertility-sparing treatment for women with CAH/G1EC. Fertility specialist involvement is recommended due to the low live birth rate without intervention. Progestin therapy should be re-evaluated at 1 year in non-responders due to a low probability of success. Hysterectomy is recommended after childbearing due to a high recurrence rate.
Authors: Henry D Reyes; Matthew J Carlson; Eric J Devor; Yuping Zhang; Kristina W Thiel; Megan I Samuelson; Megan McDonald; Shujie Yang; Jean-Marie Stephan; Erica C Savage; Donghai Dai; Michael J Goodheart; Kimberly K Leslie Journal: Gynecol Oncol Date: 2015-10-30 Impact factor: 5.482
Authors: Anne M Friel; Ling Zhang; Cindy A Pru; Nicole C Clark; Melissa L McCallum; Leen J Blok; Toshi Shioda; John J Peluso; Bo R Rueda; James K Pru Journal: Cancer Lett Date: 2014-10-07 Impact factor: 8.679