title: Adjuvant progestagens for endometrial cancer.
abstract: BACKGROUND
  Endometrial cancer is the most common genital tract carcinoma among women in developed countries, with most women presenting with stage 1 disease. Adjuvant progestagen therapy has been advocated following primary surgery to reduce the risk of recurrence of disease.
  
  
  OBJECTIVE
  To evaluate the effectiveness and safety of adjuvant progestagen therapy for the treatment of endometrial cancer.
  
  
  METHODS
  We searched the Cochrane Gynaecological Cancer Group Trials Specilaised Register, Cochrane Central Register of Controlled Trials (CENTRAL) Issue 2, 2009. MEDLINE and EMBASE up to April 2009.
  
  
  METHODS
  Randomised controlled trials (RCTs) of progestagen therapy in women who have had surgery for endometrial cancer.
  
  
  METHODS
  Two review authors independently abstracted data and assessed risk of bias. Risk ratios (RRs) comparing survival in women who did and did not receive progestagen were pooled in random effects meta-analyses. .
  
  
  RESULTS
  Seven trials assessing 4556 women were identified. Three trials included women with stage one disease only, whereas four included women with more advanced disease. Meta-analysis of four trials showed that there was no significant difference in the risk of death at five years between adjuvant progestagen therapy and no further treatment (RR = 1.00, 95% CI 0.85 to 1.18). This conclusion is also robust to single trial analyses at 4 and 7 years and in one trial across all points in time using a hazard ratio (HR). There was also no significant difference between progestagen therapy and control in terms of the risk of death from endometrial cancer, cardiovascular disease and intercurrent disease. Relapse of disease appeared to be reduced by progestagen therapy in one trial (HR = 0.71, 95% CI 0.52 to 0.97 and 5 year RR = 0.74, 95% CI 0.58 to 0.96), but there was no evidence of a difference in disease recurrence in another trial at 7 years (RR = 1.34, 95% CI 0.79 to 2.27).
  
  
  CONCLUSIONS
  There is no evidence to support the use of adjuvant progestagen therapy in the primary treatment of endometrial cancer.
authors.affiliation: Gynaecological Oncology Unit, Royal Preston Hospital, Lancashire Teaching Hospital NHS Trust, Sharoe Green Lane, Fullwood, Preston, Lancashire, UK, PR2 9HT.
authors.forename: Pierre Pl
authors.initials: PP
authors.lastname: Martin-Hirsch
authors.forename: Andrew
authors.initials: A
authors.lastname: Bryant
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Keep
authors.forename: Henry C
authors.initials: HC
authors.lastname: Kitchener
authors.forename: Richard
authors.initials: R
authors.lastname: Lilford
mesh_terms: D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D002423:Cause of Death; D017024:Chemotherapy, Adjuvant; D016889:Endometrial Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D005260:Female; D006801:Humans; D006908:Hydroxyprogesterones / Q000627:therapeutic use*; D017258:Medroxyprogesterone Acetate / Q000627:therapeutic use*; D011372:Progestins / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic
chemical_list: D018931:Antineoplastic Agents, Hormonal; D006908:Hydroxyprogesterones; D011372:Progestins; D017258:Medroxyprogesterone Acetate