Oncologic and Reproductive outcomes with progestin therapy in women with endometrial hyperplasia and grade 1 Adenocarcinoma: A systematic review

Camille C. Gunderson, Amanda Nickles Nickles Fader, Kathryn Anne Carson, Robert E. Bristow

Research output: Contribution to journalArticle

Abstract

Objective: The objective of this review was to analyze published contemporary oncologic and reproductive outcomes in women with endometrial hyperplasia or cancer undergoing medical management with progestin therapy. Methods: A systematic review of oncologic and pregnancy outcomes in women with complex atypical hyperplasia or grade 1 adenocarcinoma was performed using a comprehensive search of the MEDLINE literature. English language studies published from 2004 to 2011 which utilized hormonal therapy were identified using key words endometrial hyperplasia, endometrial cancer, fertility preservation, hormone and progestin therapy. Fisher's exact test was used to calculate statistical differences. Results: Forty-five studies with 391 study subjects were identified. The median age was 31.7 years. Therapies included medroxyprogesterone (49%), megestrol acetate (25%), levonorgestrel intrauterine device (19%), hydroxyprogesterone caproate (0.8%), and unspecified/miscellaneous progestins (13.5%). Overall, 344 women (77.7%) demonstrated a response to hormonal therapy. After a median follow up period of 39 months, a durable complete response was noted in 53.2%. The complete response rate was significantly higher for those with hyperplasia than for women with carcinoma (65.8% vs. 48.2%, p = .002). The median time to complete response was 6 months (range, 1-18 months). Recurrence after an initial response was noted in 23.2% with hyperplasia and 35.4% with carcinoma during the study periods (p = .03). Persistent disease was observed in 14.4% of women with hyperplasia and 25.4% of women with carcinoma (p = .02). During the respective study periods, 41.2% of those with hyperplasia and 34.8% with a history of carcinoma became pregnant (p = .39), with 117 live births reported. Conclusion: Based on this systematic review of the contemporary literature, endometrial hyperplasia has a significantly higher likelihood of response (66%) to hormonal therapy than grade 1 endometrial carcinoma (48%). Disease persistence is more common in women with carcinoma (25%) compared to hyperplasia (14%). Reproductive outcomes do not seem to differ between the cohorts.

Original languageEnglish (US)
Pages (from-to)477-482
Number of pages6
JournalGynecologic Oncology
Volume125
Issue number2
DOIs
StatePublished - May 2012

Fingerprint

Endometrial Hyperplasia
Progestins
Adenocarcinoma
Hyperplasia
Carcinoma
Endometrial Neoplasms
Therapeutics
Medroxyprogesterone
Megestrol Acetate
Fertility Preservation
Levonorgestrel
Intrauterine Devices
Live Birth
Pregnancy Outcome
MEDLINE
Language
Hormones
Recurrence

Keywords

  • Disease persistence
  • Endometrial carcinoma
  • Endometrial hyperplasia
  • Progestin therapy
  • Reproductive outcomes

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Oncology

Cite this

@article{3a3a030891cf4fba912768d7ca0d392c,
title = "Oncologic and Reproductive outcomes with progestin therapy in women with endometrial hyperplasia and grade 1 Adenocarcinoma: A systematic review",
abstract = "Objective: The objective of this review was to analyze published contemporary oncologic and reproductive outcomes in women with endometrial hyperplasia or cancer undergoing medical management with progestin therapy. Methods: A systematic review of oncologic and pregnancy outcomes in women with complex atypical hyperplasia or grade 1 adenocarcinoma was performed using a comprehensive search of the MEDLINE literature. English language studies published from 2004 to 2011 which utilized hormonal therapy were identified using key words endometrial hyperplasia, endometrial cancer, fertility preservation, hormone and progestin therapy. Fisher's exact test was used to calculate statistical differences. Results: Forty-five studies with 391 study subjects were identified. The median age was 31.7 years. Therapies included medroxyprogesterone (49{\%}), megestrol acetate (25{\%}), levonorgestrel intrauterine device (19{\%}), hydroxyprogesterone caproate (0.8{\%}), and unspecified/miscellaneous progestins (13.5{\%}). Overall, 344 women (77.7{\%}) demonstrated a response to hormonal therapy. After a median follow up period of 39 months, a durable complete response was noted in 53.2{\%}. The complete response rate was significantly higher for those with hyperplasia than for women with carcinoma (65.8{\%} vs. 48.2{\%}, p = .002). The median time to complete response was 6 months (range, 1-18 months). Recurrence after an initial response was noted in 23.2{\%} with hyperplasia and 35.4{\%} with carcinoma during the study periods (p = .03). Persistent disease was observed in 14.4{\%} of women with hyperplasia and 25.4{\%} of women with carcinoma (p = .02). During the respective study periods, 41.2{\%} of those with hyperplasia and 34.8{\%} with a history of carcinoma became pregnant (p = .39), with 117 live births reported. Conclusion: Based on this systematic review of the contemporary literature, endometrial hyperplasia has a significantly higher likelihood of response (66{\%}) to hormonal therapy than grade 1 endometrial carcinoma (48{\%}). Disease persistence is more common in women with carcinoma (25{\%}) compared to hyperplasia (14{\%}). Reproductive outcomes do not seem to differ between the cohorts.",
keywords = "Disease persistence, Endometrial carcinoma, Endometrial hyperplasia, Progestin therapy, Reproductive outcomes",
author = "Gunderson, {Camille C.} and {Nickles Fader}, {Amanda Nickles} and Carson, {Kathryn Anne} and Bristow, {Robert E.}",
year = "2012",
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doi = "10.1016/j.ygyno.2012.01.003",
language = "English (US)",
volume = "125",
pages = "477--482",
journal = "Gynecologic Oncology",
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T1 - Oncologic and Reproductive outcomes with progestin therapy in women with endometrial hyperplasia and grade 1 Adenocarcinoma

T2 - A systematic review

AU - Gunderson, Camille C.

AU - Nickles Fader, Amanda Nickles

AU - Carson, Kathryn Anne

AU - Bristow, Robert E.

PY - 2012/5

Y1 - 2012/5

N2 - Objective: The objective of this review was to analyze published contemporary oncologic and reproductive outcomes in women with endometrial hyperplasia or cancer undergoing medical management with progestin therapy. Methods: A systematic review of oncologic and pregnancy outcomes in women with complex atypical hyperplasia or grade 1 adenocarcinoma was performed using a comprehensive search of the MEDLINE literature. English language studies published from 2004 to 2011 which utilized hormonal therapy were identified using key words endometrial hyperplasia, endometrial cancer, fertility preservation, hormone and progestin therapy. Fisher's exact test was used to calculate statistical differences. Results: Forty-five studies with 391 study subjects were identified. The median age was 31.7 years. Therapies included medroxyprogesterone (49%), megestrol acetate (25%), levonorgestrel intrauterine device (19%), hydroxyprogesterone caproate (0.8%), and unspecified/miscellaneous progestins (13.5%). Overall, 344 women (77.7%) demonstrated a response to hormonal therapy. After a median follow up period of 39 months, a durable complete response was noted in 53.2%. The complete response rate was significantly higher for those with hyperplasia than for women with carcinoma (65.8% vs. 48.2%, p = .002). The median time to complete response was 6 months (range, 1-18 months). Recurrence after an initial response was noted in 23.2% with hyperplasia and 35.4% with carcinoma during the study periods (p = .03). Persistent disease was observed in 14.4% of women with hyperplasia and 25.4% of women with carcinoma (p = .02). During the respective study periods, 41.2% of those with hyperplasia and 34.8% with a history of carcinoma became pregnant (p = .39), with 117 live births reported. Conclusion: Based on this systematic review of the contemporary literature, endometrial hyperplasia has a significantly higher likelihood of response (66%) to hormonal therapy than grade 1 endometrial carcinoma (48%). Disease persistence is more common in women with carcinoma (25%) compared to hyperplasia (14%). Reproductive outcomes do not seem to differ between the cohorts.

AB - Objective: The objective of this review was to analyze published contemporary oncologic and reproductive outcomes in women with endometrial hyperplasia or cancer undergoing medical management with progestin therapy. Methods: A systematic review of oncologic and pregnancy outcomes in women with complex atypical hyperplasia or grade 1 adenocarcinoma was performed using a comprehensive search of the MEDLINE literature. English language studies published from 2004 to 2011 which utilized hormonal therapy were identified using key words endometrial hyperplasia, endometrial cancer, fertility preservation, hormone and progestin therapy. Fisher's exact test was used to calculate statistical differences. Results: Forty-five studies with 391 study subjects were identified. The median age was 31.7 years. Therapies included medroxyprogesterone (49%), megestrol acetate (25%), levonorgestrel intrauterine device (19%), hydroxyprogesterone caproate (0.8%), and unspecified/miscellaneous progestins (13.5%). Overall, 344 women (77.7%) demonstrated a response to hormonal therapy. After a median follow up period of 39 months, a durable complete response was noted in 53.2%. The complete response rate was significantly higher for those with hyperplasia than for women with carcinoma (65.8% vs. 48.2%, p = .002). The median time to complete response was 6 months (range, 1-18 months). Recurrence after an initial response was noted in 23.2% with hyperplasia and 35.4% with carcinoma during the study periods (p = .03). Persistent disease was observed in 14.4% of women with hyperplasia and 25.4% of women with carcinoma (p = .02). During the respective study periods, 41.2% of those with hyperplasia and 34.8% with a history of carcinoma became pregnant (p = .39), with 117 live births reported. Conclusion: Based on this systematic review of the contemporary literature, endometrial hyperplasia has a significantly higher likelihood of response (66%) to hormonal therapy than grade 1 endometrial carcinoma (48%). Disease persistence is more common in women with carcinoma (25%) compared to hyperplasia (14%). Reproductive outcomes do not seem to differ between the cohorts.

KW - Disease persistence

KW - Endometrial carcinoma

KW - Endometrial hyperplasia

KW - Progestin therapy

KW - Reproductive outcomes

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