title: Long-term outcomes of fertility-sparing treatment of atypical polypoid adenomyoma with medroxyprogesterone acetate.
abstract: OBJECTIVE
  Our objective was to analyze the long-term oncologic outcomes of fertility-preserving hormonal treatment with medroxyprogesterone acetate (MPA) in patients with APA.
  
  
  METHODS
  In a retrospective chart review, we identified patients with APA who were treated with MPA for fertility preservation at our hospital between 2001 and 2011. Eighteen patients with histologically diagnosed APA were identified. Clinical data including treatment, obstetrical, and oncologic outcomes were recorded.
  
  
  RESULTS
  The mean observation period was 77.6 months (median 73.5, range 22-142), and the mean age was 33.6 years. Four patients also developed well-differentiated endometrial carcinoma. After the treatment, 14 patients (77.8 %) achieved either a complete response or partial response. Eight patients experienced recurrence, while four experienced persistent disease. Ten patients (55.6 %) eventually underwent hysterectomy. The median time to hysterectomy was 40.3 months (range 24-68). Nine patients progressed to endometrial cancer, and one experienced persistent APA. Among younger patients (<35 years of age), four out of five patients who were married could have children. Seven patients (38.9 %) showed no evidence of the disease during the observation period (median 60 months, range 22-117 months). No one died because of the disease during the observation period.
  
  
  CONCLUSIONS
  MPA yields a high response rate in APA, and if only younger patients are considered, a favorable pregnancy rate can be obtained. However, because recurrence rate is high, long-term follow-up under supervision of a trained gynecologic oncologist is required. To confirm MPA's utility, multi-center collaboration would be warranted.
authors.affiliation: Department of Gynecology, Cancer Institute Hospital, Ariake 3-8-31, Koto-ku, Tokyo, 135-8550, Japan. hidetaka.nomura@jfcr.or.jp.
authors.forename: Hidetaka
authors.initials: H
authors.lastname: Nomura
authors.affiliation: Department of Gynecology, Cancer Institute Hospital, Ariake 3-8-31, Koto-ku, Tokyo, 135-8550, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Sugiyama
authors.affiliation: Department of Gynecology, Cancer Institute Hospital, Ariake 3-8-31, Koto-ku, Tokyo, 135-8550, Japan.
authors.forename: Terumi
authors.initials: T
authors.lastname: Tanigawa
authors.affiliation: Department of Gynecology, Cancer Institute Hospital, Ariake 3-8-31, Koto-ku, Tokyo, 135-8550, Japan.
authors.forename: Maki
authors.initials: M
authors.lastname: Matoda
authors.affiliation: Department of Gynecology, Cancer Institute Hospital, Ariake 3-8-31, Koto-ku, Tokyo, 135-8550, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kanao
authors.affiliation: Department of Gynecology, Cancer Institute Hospital, Ariake 3-8-31, Koto-ku, Tokyo, 135-8550, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Kondo
authors.affiliation: Department of Gynecology, Cancer Institute Hospital, Ariake 3-8-31, Koto-ku, Tokyo, 135-8550, Japan.
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Takeshima
mesh_terms: D018194:Adenomyoma / Q000188:drug therapy* / Q000473:pathology; D000328:Adult; D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D018269:Carcinoma, Endometrioid / Q000188:drug therapy / Q000473:pathology; D016889:Endometrial Neoplasms / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D005298:Fertility; D059247:Fertility Preservation; D006801:Humans; D007044:Hysterectomy; D017258:Medroxyprogesterone Acetate / Q000627:therapeutic use*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy; D009367:Neoplasm Staging; D011247:Pregnancy; D018873:Pregnancy Rate; D011379:Prognosis; D012074:Remission Induction; D012189:Retrospective Studies; D013997:Time Factors; D014594:Uterine Neoplasms / Q000188:drug therapy* / Q000473:pathology
chemical_list: D018931:Antineoplastic Agents, Hormonal; D017258:Medroxyprogesterone Acetate
keywords: Atypical polypoid adenomyoma; Fertility-sparing treatment; Long-term outcomes; Medroxyprogesterone acetate