子宮体がん・子宮内膜異型増殖症に対する高用量メドロキシプロゲステロン酢酸療法後の子宮内再発症例に対する再投与の検討

Objective : Although high-dose medroxyprogesterone acetate (MPA) has been used as a fertility-preserving therapy for early stage, G1 endometrioid carcinoma and atypical endometrial hyperplasia (AEH), the therapy was associated with a high recurrence rate. However, there is little evidence regarding the usefulness of readministration of MPA for intrauterine recurrence, therefore, we investigated its effectiveness and safety.<br>Methods : We retrospectively analyzed 29 patients of endometrioid carcinoma G1 and AEH who underwent high-dose MPA therapy from 1998 to 2020 at Shinshu University hospital.<br>Results : Of a total 29 patients, eight were endometrioid carcinoma G1, and 21 were AEH. The median age at the start of the first MPA therapy was 34 years (25-46 years), and the complete response (CR) rate was 88％ for endometrioid carcinoma G1 and 95％ for AEH. The recurrence rate was 78％ (21 of 27 CR patients). Eight patients (endometrioid carcinoma G1 : two patients, AEH : six patients) underwent the re-administration of MPA, and the CR rate was 100％. A total hysterectomy was finally performed on 18 patients, all patients are alive and disease-free. Eight of 12 patients (67％) who attempted pregnancy after high-dose MPA therapy achieved pregnancy, and six patients (50％) delivered a healthy full-term live birth. Only after MPA re-administration, the rate was 50％.<br>Conclusion : Although this study was conducted in a small number of cases, the CR rate with MPA readministration was high, and several cases achieved live births, therefore, it was considered to be a treatment option.