title: Reproductive and oncologic outcomes after progestin therapy for endometrial complex atypical hyperplasia or carcinoma.
abstract: OBJECTIVE
  This study evaluated fertility and oncological outcomes in women with complex atypical hyperplasia (CAH) or nonmyoinvasive grade 1 endometrioid endometrial carcinoma (EM) who desired fertility-sparing therapy.
  
  
  METHODS
  The retrospective cohort study included women younger than 45 years with CAH or EM who desired fertility-sparing treatment at our institution. Only patients for whom both oncological treatment and pregnancy outcomes were available were included. Statistical analyses were performed using a Fisher exact test, Pearson χ(2) test, and Spearman rank correlation test, as appropriate.
  
  
  RESULTS
  Seventy-five patients were identified, and 23 (13 CAH, 10 EM) met the inclusion criteria. All 23 patients had at least 1 prior pregnancy. Treatment was split between oral progesterone only (38.5% CAH, 40% EM), levonorgestrel intrauterine device only (30.8% CAH, 20% EM), and both (30.8% CAH, 40% EM). After a median follow-up of 13 months (range, 3-74 months), 9 patients (46.2% CAH, 30% EM, P = .39) had persistent/progressive disease. Eight patients (30.8% CAH, 40% EM, P = .69) ultimately had a hysterectomy, and 3 of these (13.0%) were found to have persistent/progressive disease. Median time from diagnosis to hysterectomy was 13 months (range, 4-56 months). Fourteen of the 23 patients utilized assisted reproductive techniques (60.9%); 12 underwent IVF and 2 chose a gestation carrier. Seven clinical intrauterine pregnancies (30.4%) resulting in 6 live births (26.1%) were found in the entire cohort.
  
  
  CONCLUSIONS
  Fertility-sparing treatment for CAH and grade 1 endometrial cancer is feasible with progestin therapy and leads to clinically meaningful rates of pregnancy in young women who desire fertility.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Weill Cornell Medical College-New York Presbyterian Hospital, New York, NY.
authors.forename: Rashmi
authors.initials: R
authors.lastname: Kudesia
authors.affiliation: Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College-New York Presbyterian Hospital, New York, NY.
authors.forename: Tomer
authors.initials: T
authors.lastname: Singer
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Weill Cornell Medical College-New York Presbyterian Hospital, New York, NY.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Caputo
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Weill Cornell Medical College-New York Presbyterian Hospital, New York, NY.
authors.forename: Kevin Michael
authors.initials: KM
authors.lastname: Holcomb
authors.affiliation: Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College-New York Presbyterian Hospital, New York, NY.
authors.forename: Isaac
authors.initials: I
authors.lastname: Kligman
authors.affiliation: Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College-New York Presbyterian Hospital, New York, NY.
authors.forename: Zev
authors.initials: Z
authors.lastname: Rosenwaks
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Weill Cornell Medical College-New York Presbyterian Hospital, New York, NY. Electronic address: dig2010@med.cornell.edu.
authors.forename: Divya
authors.initials: D
authors.lastname: Gupta
mesh_terms: D000328:Adult; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D002277:Carcinoma / Q000188:drug therapy*; D004714:Endometrial Hyperplasia / Q000188:drug therapy*; D016889:Endometrial Neoplasms / Q000188:drug therapy*; D005260:Female; D059247:Fertility Preservation; D006801:Humans; D007436:Intrauterine Devices, Medicated; D016912:Levonorgestrel / Q000627:therapeutic use*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011374:Progesterone / Q000627:therapeutic use*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D018931:Antineoplastic Agents, Hormonal; D011374:Progesterone; D016912:Levonorgestrel
keywords: endometrial cancer; endometrial hyperplasia; fertility-sparing treatment; progestin therapy