Intervention Review

Adjuvant progestagens for endometrial cancer

  1. Pierre PL Martin-Hirsch1,*,
  2. Andrew Bryant2,
  3. Sarah L Keep1,
  4. Henry C Kitchener3,
  5. Richard Lilford4

Editorial Group: Cochrane Gynaecological Cancer Group

Published Online: 15 JUN 2011

Assessed as up-to-date: 9 MAY 2011

DOI: 10.1002/14651858.CD001040.pub2

Database Title

Additional Information

How to Cite

Martin-Hirsch PPL, Bryant A, Keep SL, Kitchener HC, Lilford R. Adjuvant progestagens for endometrial cancer. Cochrane Database of Systematic Reviews 2011, Issue 6. Art. No.: CD001040. DOI: 10.1002/14651858.CD001040.pub2.

Author Information

  1. 1

    Royal Preston Hospital, Lancashire Teaching Hospital NHS Trust, Gynaecological Oncology Unit, Preston, Lancashire, UK

  2. 2

    Newcastle University, Institute of Health and Society, Newcastle upon Tyne, UK

  3. 3

    St. Mary's Hospital, Academic Unit of Obstetrics and Gynaecology, University of Manchester, Manchester, UK

  4. 4

    University of Birmingham, Department of Public Health and Epidemiology, Birmingham, UK

*Pierre PL Martin-Hirsch, Gynaecological Oncology Unit, Royal Preston Hospital, Lancashire Teaching Hospital NHS Trust, Sharoe Green Lane, Fullwood, Preston, Lancashire, PR2 9HT, UK. pierre.martinhirsch@btinternet.com.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 15 JUN 2011

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary

Background

Endometrial cancer is the most common genital tract carcinoma among women in developed countries, with most women presenting with stage 1 disease. Adjuvant progestagen therapy has been advocated following primary surgery to reduce the risk of recurrence of disease.

Objectives

To evaluate the effectiveness and safety of adjuvant progestagen therapy for the treatment of endometrial cancer.

Search methods

We searched the Cochrane Gynaecological Cancer Group Trials Specilaised Register, Cochrane Central Register of Controlled Trials (CENTRAL) Issue 2, 2009. MEDLINE and EMBASE up to April 2009.

Selection criteria

Randomised controlled trials (RCTs) of progestagen therapy in women who have had surgery for endometrial cancer.

Data collection and analysis

Two review authors independently abstracted data and assessed risk of bias. Risk ratios (RRs) comparing survival in women who did and did not receive progestagen were pooled in random effects meta-analyses. .

Main results

Seven trials assessing 4556 women were identified. Three trials included women with stage one disease only, whereas four included women with more advanced disease. Meta-analysis of four trials showed that there was no significant difference in the risk of death at five years between adjuvant progestagen therapy and no further treatment (RR = 1.00, 95% CI 0.85 to 1.18). This conclusion is also robust to single trial analyses at 4 and 7 years and in one trial across all points in time using a hazard ratio (HR). There was also no significant difference between progestagen therapy and control in terms of the risk of death from endometrial cancer, cardiovascular disease and intercurrent disease. Relapse of disease appeared to be reduced by progestagen therapy in one trial (HR = 0.71, 95% CI 0.52 to 0.97 and 5 year RR = 0.74, 95% CI 0.58 to 0.96), but there was no evidence of a difference in disease recurrence in another trial at 7 years (RR = 1.34, 95% CI 0.79 to 2.27).

Authors' conclusions

There is no evidence to support the use of adjuvant progestagen therapy in the primary treatment of endometrial cancer.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary

No evidence to support use of adjuvant progestagens to prevent recurrence of endometrial cancer after surgery

Endometrial (womb) cancer is the most common genital tract cancer in developed countries. Progestagen (a hormone) therapy is sometimes used following initial surgery to reduce the risk of recurrence. However, progestagens have been found to reduce one of the protective factors against heart disease and may also make tumours more resistant to radiotherapy. This review found no evidence to support the use of progestagen as an addition to surgery for newly diagnosed endometrial cancer. Progestagen can, however, prevent or delay recurrence of cancer in some patients.

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