title: Fertility sparing treatment of complex atypical hyperplasia and low grade endometrial cancer using oral progestin.
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.
  
  
  CONCLUSIONS
  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.affiliation: 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.
authors.forename: Andrea N
authors.initials: AN
authors.lastname: Simpson
authors.affiliation: 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.
authors.forename: Tomer
authors.initials: T
authors.lastname: Feigenberg
authors.affiliation: 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.
authors.forename: Blaise A
authors.initials: BA
authors.lastname: Clarke
authors.affiliation: 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.
authors.forename: Lilian T
authors.initials: LT
authors.lastname: Gien
authors.affiliation: Department of Pathology and Laboratory Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, Ontario M4N 3M5, Canada. Electronic address: nadia.ismiil@sunnybrook.ca.
authors.forename: Nadia
authors.initials: N
authors.lastname: Ismiil
authors.affiliation: 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.
authors.forename: Stephane
authors.initials: S
authors.lastname: Laframboise
authors.affiliation: Independent Biostatistician, 93 George St. South, Ste 221, Brampton, Ontario L6Y 1P4, Canada. Electronic address: cmssyc@gmail.com.
authors.forename: Christine
authors.initials: C
authors.lastname: Massey
authors.affiliation: 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.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Ferguson
mesh_terms: D000328:Adult; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D018269:Carcinoma, Endometrioid / Q000188:drug therapy* / Q000473:pathology; D004714:Endometrial Hyperplasia / Q000188:drug therapy*; D016889:Endometrial Neoplasms / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D059247:Fertility Preservation / Q000379:methods; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data; D017258:Medroxyprogesterone Acetate / Q000627:therapeutic use*; D019290:Megestrol Acetate / Q000627:therapeutic use*; D060787:Neoplasm Grading; D059351:Organ Sparing Treatments / Q000379:methods; D011247:Pregnancy; D011256:Pregnancy Outcome; D018873:Pregnancy Rate; D027724:Reproductive Techniques, Assisted / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D018931:Antineoplastic Agents, Hormonal; D017258:Medroxyprogesterone Acetate; D019290:Megestrol Acetate
keywords: Conservative treatment; Endometrial atypical hyperplasia; Endometrial cancer; Fertility sparing; Progestin therapy