Efficacy and fertility outcomes of levonorgestrel-releasing intra-uterine system treatment for patients with atypical complex hyperplasia or endometrial cancer: a retrospective study

Umberto Leone Roberti Maggiore, Fabio Martinelli, Giulia Dondi, Giorgio Bogani, Valentina Chiappa, Maria Teresa Evangelista, Viola Liberale, Antonino Ditto, Simone Ferrero, Francesco Raspagliesi

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Abstract

OBJECTIVE: To investigate the efficacy of levonorgestrel-releasing intra-uterine system (LNG-IUS) treatment in patients affected by atypical complex hyperplasia/endometrial cancer (ACH/EC) wishing to preserve their fertility and to present fertility outcomes of those patients who actively tried to conceive. METHODS: Data of consecutive women with ACH/EC who underwent fertility-sparing treatment using LNG-IUS were retrospectively evaluated. RESULTS: Overall, 48 patients and the mean (±standard deviation) length of follow-up was 82.6±47.2 months. Among patients with ACH, 25/28 (89.3%) had a complete response (CR), 2/28 (7.1%) had a partial response (PR) and 1/28 (3.6%) had a progressive disease (PD). Mean (±standard deviation) time to CR was 6.7±4.0 months. Among patients with G1 EC, 13/16 (81.3%) had a CR, 1/16 (6.3%) had a PR and 2/16 (12.5%) had a PD. Mean (±standard deviation) time to CR was 5.0±2.9 months. Among patients with G2 EC, 3/4 (75.0%) had a CR and 1/4 (25.0%) had a PD. Mean (±standard deviation) time to CR was 4.0±0 months. Only 19 (39.6%) patients who had CR actually attempted to conceive. Eleven (57.9%) women tried to conceive naturally while 8 (42.1%) women underwent an in vitro fertilization (IVF). Fourteen (73.7%) patients wishing to conceive achieved a pregnancy (6 spontaneously and 8 through IVF). CONCLUSIONS: Fertility-sparing treatment of patient with ACH/EC with LNG-IUS achieves high regression rates and good fertility outcomes. Future larger multi-institutional studies should be designed to confirm these preliminary findings.

Original languageEnglish
Pages (from-to)e57
JournalJournal of Gynecologic Oncology
Volume30
Issue number4
DOIs
Publication statusPublished - Jul 1 2019

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Levonorgestrel
Endometrial Neoplasms
Hyperplasia
Fertility
Retrospective Studies
Therapeutics
Fertilization in Vitro
Birth Rate
Pregnancy

Keywords

  • Endometrial Cancer
  • Fertility
  • Hyperplasia
  • Levonorgestrel
  • Pregnancy

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynaecology

Cite this

@article{4c6046a2338a452593bdb77c85671297,
title = "Efficacy and fertility outcomes of levonorgestrel-releasing intra-uterine system treatment for patients with atypical complex hyperplasia or endometrial cancer: a retrospective study",
abstract = "OBJECTIVE: To investigate the efficacy of levonorgestrel-releasing intra-uterine system (LNG-IUS) treatment in patients affected by atypical complex hyperplasia/endometrial cancer (ACH/EC) wishing to preserve their fertility and to present fertility outcomes of those patients who actively tried to conceive. METHODS: Data of consecutive women with ACH/EC who underwent fertility-sparing treatment using LNG-IUS were retrospectively evaluated. RESULTS: Overall, 48 patients and the mean (±standard deviation) length of follow-up was 82.6±47.2 months. Among patients with ACH, 25/28 (89.3{\%}) had a complete response (CR), 2/28 (7.1{\%}) had a partial response (PR) and 1/28 (3.6{\%}) had a progressive disease (PD). Mean (±standard deviation) time to CR was 6.7±4.0 months. Among patients with G1 EC, 13/16 (81.3{\%}) had a CR, 1/16 (6.3{\%}) had a PR and 2/16 (12.5{\%}) had a PD. Mean (±standard deviation) time to CR was 5.0±2.9 months. Among patients with G2 EC, 3/4 (75.0{\%}) had a CR and 1/4 (25.0{\%}) had a PD. Mean (±standard deviation) time to CR was 4.0±0 months. Only 19 (39.6{\%}) patients who had CR actually attempted to conceive. Eleven (57.9{\%}) women tried to conceive naturally while 8 (42.1{\%}) women underwent an in vitro fertilization (IVF). Fourteen (73.7{\%}) patients wishing to conceive achieved a pregnancy (6 spontaneously and 8 through IVF). CONCLUSIONS: Fertility-sparing treatment of patient with ACH/EC with LNG-IUS achieves high regression rates and good fertility outcomes. Future larger multi-institutional studies should be designed to confirm these preliminary findings.",
keywords = "Endometrial Cancer, Fertility, Hyperplasia, Levonorgestrel, Pregnancy",
author = "{Leone Roberti Maggiore}, Umberto and Fabio Martinelli and Giulia Dondi and Giorgio Bogani and Valentina Chiappa and Evangelista, {Maria Teresa} and Viola Liberale and Antonino Ditto and Simone Ferrero and Francesco Raspagliesi",
year = "2019",
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journal = "Journal of Gynecologic Oncology",
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TY - JOUR

T1 - Efficacy and fertility outcomes of levonorgestrel-releasing intra-uterine system treatment for patients with atypical complex hyperplasia or endometrial cancer

T2 - a retrospective study

AU - Leone Roberti Maggiore, Umberto

AU - Martinelli, Fabio

AU - Dondi, Giulia

AU - Bogani, Giorgio

AU - Chiappa, Valentina

AU - Evangelista, Maria Teresa

AU - Liberale, Viola

AU - Ditto, Antonino

AU - Ferrero, Simone

AU - Raspagliesi, Francesco

PY - 2019/7/1

Y1 - 2019/7/1

N2 - OBJECTIVE: To investigate the efficacy of levonorgestrel-releasing intra-uterine system (LNG-IUS) treatment in patients affected by atypical complex hyperplasia/endometrial cancer (ACH/EC) wishing to preserve their fertility and to present fertility outcomes of those patients who actively tried to conceive. METHODS: Data of consecutive women with ACH/EC who underwent fertility-sparing treatment using LNG-IUS were retrospectively evaluated. RESULTS: Overall, 48 patients and the mean (±standard deviation) length of follow-up was 82.6±47.2 months. Among patients with ACH, 25/28 (89.3%) had a complete response (CR), 2/28 (7.1%) had a partial response (PR) and 1/28 (3.6%) had a progressive disease (PD). Mean (±standard deviation) time to CR was 6.7±4.0 months. Among patients with G1 EC, 13/16 (81.3%) had a CR, 1/16 (6.3%) had a PR and 2/16 (12.5%) had a PD. Mean (±standard deviation) time to CR was 5.0±2.9 months. Among patients with G2 EC, 3/4 (75.0%) had a CR and 1/4 (25.0%) had a PD. Mean (±standard deviation) time to CR was 4.0±0 months. Only 19 (39.6%) patients who had CR actually attempted to conceive. Eleven (57.9%) women tried to conceive naturally while 8 (42.1%) women underwent an in vitro fertilization (IVF). Fourteen (73.7%) patients wishing to conceive achieved a pregnancy (6 spontaneously and 8 through IVF). CONCLUSIONS: Fertility-sparing treatment of patient with ACH/EC with LNG-IUS achieves high regression rates and good fertility outcomes. Future larger multi-institutional studies should be designed to confirm these preliminary findings.

AB - OBJECTIVE: To investigate the efficacy of levonorgestrel-releasing intra-uterine system (LNG-IUS) treatment in patients affected by atypical complex hyperplasia/endometrial cancer (ACH/EC) wishing to preserve their fertility and to present fertility outcomes of those patients who actively tried to conceive. METHODS: Data of consecutive women with ACH/EC who underwent fertility-sparing treatment using LNG-IUS were retrospectively evaluated. RESULTS: Overall, 48 patients and the mean (±standard deviation) length of follow-up was 82.6±47.2 months. Among patients with ACH, 25/28 (89.3%) had a complete response (CR), 2/28 (7.1%) had a partial response (PR) and 1/28 (3.6%) had a progressive disease (PD). Mean (±standard deviation) time to CR was 6.7±4.0 months. Among patients with G1 EC, 13/16 (81.3%) had a CR, 1/16 (6.3%) had a PR and 2/16 (12.5%) had a PD. Mean (±standard deviation) time to CR was 5.0±2.9 months. Among patients with G2 EC, 3/4 (75.0%) had a CR and 1/4 (25.0%) had a PD. Mean (±standard deviation) time to CR was 4.0±0 months. Only 19 (39.6%) patients who had CR actually attempted to conceive. Eleven (57.9%) women tried to conceive naturally while 8 (42.1%) women underwent an in vitro fertilization (IVF). Fourteen (73.7%) patients wishing to conceive achieved a pregnancy (6 spontaneously and 8 through IVF). CONCLUSIONS: Fertility-sparing treatment of patient with ACH/EC with LNG-IUS achieves high regression rates and good fertility outcomes. Future larger multi-institutional studies should be designed to confirm these preliminary findings.

KW - Endometrial Cancer

KW - Fertility

KW - Hyperplasia

KW - Levonorgestrel

KW - Pregnancy

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