Retreatment with progestin for recurrence after achieving complete response with fertility sparing hormonal treatment in patients with early endometrial cancer (095)

Abstract

<b>Objectives:</b> To assess the outcomes of retreatment using progestin in patients with recurrent endometrial cancer (EC) after achieving complete response (CR) with fertility-sparing hormonal treatment. <b>Methods:</b> We retrospectively reviewed patients who had recurrence after achieving CR by fertility-sparing treatment using progestin with presumed stage IA, grade 1, endometrioid EC from 2005 to 2020. All recurrent patients were given medroxyprogesterone acetate or megestrol acetate with concurrent LNG-IUD. The primary endpoint was a response rate. The secondary endpoints were pregnancy outcome, pathologic disease progression, and 2^nd recurrence rate. <b>Results:</b> Of 55 recurrent patients, 50 received progestin retreatment. With a median retreatment duration of eight (3-56) months, the CR rate of the retreatment group was 78% (39/50); 76.2% in the EC group, and 87.5% in the endometrial intraepithelial neoplasia group. Of 11 patients not achieving CR to progestin retreatment, three underwent surgical treatment, and none had extrauterine spread of disease. Of twenty patients who attempted to conceive after achieving CR, ten became pregnant. These pregnancies resulted in three (30%) abortions, one (10.0%) preterm (12.5%), and six (60%) full-term births. Of the 39 patients achieving CR after 1^st recurrence, 18 (46.1%) patients had 2^nd recurrence with a median follow-up duration of 14 (3-36) months. Of those, 15 patients received second-line progestin retreatment, and nine (60%) of these patients achieved CR. All patients who underwent retreatment are alive without evidence of disease. <b>Conclusions:</b> First-line and second-line progestin retreatment in patients with recurrent endometrial cancer are as effective and safe as initial fertility-sparing treatment. Therefore, it may provide an opportunity to young patients who still want to preserve fertility after recurrence.