title: Progestin re-treatment in patients with recurrent endometrial adenocarcinoma after successful fertility-sparing management using progestin.
abstract: OBJECTIVE
  To analyze the outcomes of second round of fertility-sparing management using progestin in patients with recurrent endometrial cancer after successful fertility-sparing management using progestin.
  
  
  METHODS
  We reviewed 45 patients who had recurrence after achieving complete remission by fertility-sparing management using progestin for presumed stage IA, grade 1, endometrioid adenocarcinoma of the uterus. Of 45 patients, 33 tried progestin re-treatment at recurrence and were included in this study.
  
  
  RESULTS
  Recurrent disease was atypical hyperplasia in 13 patients (39%) and grade 1 endometrioid adenocarcinoma in 20 patients (61%) which were confined to the endometrium. Thirty patients (91%) received medroxyprogesterone acetate (dose range, 80-500 mg/day) and three patients (9%) received megestrol acetate (dose range, 80-160 mg/day), with 29 patients receiving a dose of 500 mg/day of medroxyprogesterone acetate. The median duration of treatment was 6 months (range, 3-19 months). Five patients failed to respond to progestin re-treatment and underwent definitive surgical treatment including hysterectomy. Twenty eight patients (85%) showed complete response to progestin re-treatment. The median follow-up time after progestin re-treatment in 28 patients who achieved complete remission was 51 months (range, 24-160 months). During follow-up, five patients had second recurrence after median time interval of 14 months (range, 4-82 months). All patients who tried progestin re-treatment are alive without evidence of disease.
  
  
  CONCLUSIONS
  Progestin re-treatment in patients with recurrent endometrial cancer was effective and safe. Therefore, this can be recommended for young women who still want to preserve fertility at recurrence after complete response to progestin.
authors.affiliation: Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea.
authors.forename: Jeong-Yeol
authors.initials: JY
authors.lastname: Park
authors.forename: Sang-Hun
authors.initials: SH
authors.lastname: Lee
authors.forename: Seok Ju
authors.initials: SJ
authors.lastname: Seong
authors.forename: Dae-Yeon
authors.initials: DY
authors.lastname: Kim
authors.forename: Tae-Jin
authors.initials: TJ
authors.lastname: Kim
authors.forename: Jae Weon
authors.initials: JW
authors.lastname: Kim
authors.forename: Jong-Hyeok
authors.initials: JH
authors.lastname: Kim
authors.forename: Yong-Man
authors.initials: YM
authors.lastname: Kim
authors.forename: Young-Tak
authors.initials: YT
authors.lastname: Kim
authors.forename: Duk-Soo
authors.initials: DS
authors.lastname: Bae
authors.forename: Joo-Hyun
authors.initials: JH
authors.lastname: Nam
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy*; D000328:Adult; D016889:Endometrial Neoplasms / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D059247:Fertility Preservation; D005500:Follow-Up Studies; D006801:Humans; D017258:Medroxyprogesterone Acetate / Q000627:therapeutic use; D019290:Megestrol Acetate / Q000627:therapeutic use; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000503:physiopathology; D011372:Progestins / Q000009:adverse effects / Q000627:therapeutic use*; D012008:Recurrence
chemical_list: D011372:Progestins; D017258:Medroxyprogesterone Acetate; D019290:Megestrol Acetate