title: Efficacies and pregnant outcomes of fertility-sparing treatment with medroxyprogesterone acetate for endometrioid adenocarcinoma and complex atypical hyperplasia: our experience and a review of the literature.
abstract: OBJECTIVE
  We retrospectively analyzed oncologic and reproductive outcomes of fertility-seeking premenopausal women with complex atypical hyperplasia (CAH) or Grade 1 endometrial adenocarcinoma (G1EA) who underwent medical management with high-dose medroxyprogesterone acetate (MPA) therapy.
  
  
  METHODS
  Patients were given a dose of 400-600 mg of MPA orally on a daily basis. They had histologically confirmed CAH or G1EA at presumed stage IA and wished to preserve fertility. Endometrial tissue sampling was carried out by dilation and curettage before and after the treatment and the pathologic response to MPA treatment was assessed.
  
  
  RESULTS
  A total of 27 premenopausal patients received MPA therapy. The median follow-up time was 39.2 months (3.4-153.8 months). Complete response was achieved in 81.8 % (9/11) of CAH cases and 68.8 % (11/16) of G1EA. Although no recurrences were found in CAH patients, nine G1EA patients (81.8 %) eventually recurred and underwent total hysterectomy. Neither therapeutic death nor irreversible toxicities were observed during the follow-up periods. Five patients (4 CAH and 1 G1EA) became pregnant and had nine live births.
  
  
  CONCLUSIONS
  The high efficacy of fertility-sparing treatment with MPA was shown demonstrated. MPA therapy can be considered acceptable for the purpose of enabling patients to preserve their fertility. However, the rate of recurrence was high in patients with G1EA. Even in responders, close follow-up is required and a total hysterectomy needs to be considered without delay. Patients should be aware of the risks and limitations of this conservative treatment.
authors.affiliation: Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, 2-2, Yamadaoka Suita, Osaka, 5650871, Japan.
authors.forename: Chifumi
authors.initials: C
authors.lastname: Ohyagi-Hara
authors.forename: Kenjiro
authors.initials: K
authors.lastname: Sawada
authors.forename: Isobe
authors.initials: I
authors.lastname: Aki
authors.forename: Seiji
authors.initials: S
authors.lastname: Mabuchi
authors.forename: Eiji
authors.initials: E
authors.lastname: Kobayashi
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Ueda
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Yoshino
authors.forename: Masami
authors.initials: M
authors.lastname: Fujita
authors.forename: Tateki
authors.initials: T
authors.lastname: Tsutsui
authors.forename: Tadashi
authors.initials: T
authors.lastname: Kimura
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 / Q000473:pathology; D016889:Endometrial Neoplasms / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D059247:Fertility Preservation; D006801:Humans; D007044:Hysterectomy; D017258:Medroxyprogesterone Acetate / Q000627:therapeutic use*; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy; D011247:Pregnancy; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D018931:Antineoplastic Agents, Hormonal; D017258:Medroxyprogesterone Acetate