Long-Term Oncologic and Reproductive Outcomes in Young Women with Early Endometrial Cancer Conservatively Treated: A Prospective Study and Literature Update

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Abstract

Objective This study aimed to analyze the long-term oncologic and reproductive outcomes in endometrial cancer (EC) in young patients conservatively treated by combined hysteroscopic resection (HR) and levonorgestrel intrauterine device (LNG-IUD). Methods Twenty-one patients (age ≤ 40 years; Stage IA, G1-2 endometrioid EC), wishing to preserve their fertility, were enrolled into this prospective study. The HR was used to resect (1) the tumor lesion, (2) the endometrium adjacent to the tumor, and (3) the myometrium underlying the tumor. Hormonal therapy consisted of LNG-IUD (52 mg) for at least 6 months. Results The median follow-up time is 85 months (range, 30-114). After 3 months from the progestin start date, 18 patients (85.7%) showed a complete regression (CR), 2 (9.5%) showed persistent disease, whereas 1 patient (4.8%) presented with progressive disease and underwent definitive surgery (Stage IA, G3 endometrioid). At 6 months, 1 of the 2 persistences underwent definitive surgery (Stage IA, G1 endometrioid), whereas the other was successfully re-treated. Two recurrences (10.5%) were observed, both involving the endometrium and synchronous ovarian cancer (OC) (atypical hyperplasia and Stage IIB G1 endometrioid OC; Stage IA endometrioid G1 EC, and Stage IA G1 endometrioid OC). The median duration of complete response was 85 months (range, 8-117). Sixty-three percent of complete responders attempted to conceive with 92% and 83% pregnancy and live birth rates, respectively. To date, all patients are alive and have no evidence of disease. Conclusions After a long follow-up, combined HR and LNG-IUD would seem to improve the efficacy of progestin alone. High pregnancy and live birth rates were observed in women attempting to conceive. This approach is still experimental and should be offered only in the framework of scientific protocols conducted in cancer centers.

Original languageEnglish
Pages (from-to)1650-1657
Number of pages8
JournalInternational Journal of Gynecological Cancer
Volume26
Issue number9
DOIs
Publication statusPublished - Nov 1 2016

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Endometrial Neoplasms
Levonorgestrel
Intrauterine Devices
Prospective Studies
Ovarian Neoplasms
Progestins
Pregnancy Rate
Endometrium
Neoplasms
Myometrium
Hyperplasia
Fertility
Recurrence
Therapeutics

Keywords

  • Endometrial cancer
  • Fertility preservation
  • Hormonal therapy
  • Hysteroscopic surgery

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynaecology

Cite this

@article{0486b0da5f564eadbd338c2b5526cd96,
title = "Long-Term Oncologic and Reproductive Outcomes in Young Women with Early Endometrial Cancer Conservatively Treated: A Prospective Study and Literature Update",
abstract = "Objective This study aimed to analyze the long-term oncologic and reproductive outcomes in endometrial cancer (EC) in young patients conservatively treated by combined hysteroscopic resection (HR) and levonorgestrel intrauterine device (LNG-IUD). Methods Twenty-one patients (age ≤ 40 years; Stage IA, G1-2 endometrioid EC), wishing to preserve their fertility, were enrolled into this prospective study. The HR was used to resect (1) the tumor lesion, (2) the endometrium adjacent to the tumor, and (3) the myometrium underlying the tumor. Hormonal therapy consisted of LNG-IUD (52 mg) for at least 6 months. Results The median follow-up time is 85 months (range, 30-114). After 3 months from the progestin start date, 18 patients (85.7{\%}) showed a complete regression (CR), 2 (9.5{\%}) showed persistent disease, whereas 1 patient (4.8{\%}) presented with progressive disease and underwent definitive surgery (Stage IA, G3 endometrioid). At 6 months, 1 of the 2 persistences underwent definitive surgery (Stage IA, G1 endometrioid), whereas the other was successfully re-treated. Two recurrences (10.5{\%}) were observed, both involving the endometrium and synchronous ovarian cancer (OC) (atypical hyperplasia and Stage IIB G1 endometrioid OC; Stage IA endometrioid G1 EC, and Stage IA G1 endometrioid OC). The median duration of complete response was 85 months (range, 8-117). Sixty-three percent of complete responders attempted to conceive with 92{\%} and 83{\%} pregnancy and live birth rates, respectively. To date, all patients are alive and have no evidence of disease. Conclusions After a long follow-up, combined HR and LNG-IUD would seem to improve the efficacy of progestin alone. High pregnancy and live birth rates were observed in women attempting to conceive. This approach is still experimental and should be offered only in the framework of scientific protocols conducted in cancer centers.",
keywords = "Endometrial cancer, Fertility preservation, Hormonal therapy, Hysteroscopic surgery",
author = "Giuseppe Laurelli and Francesca Falcone and Maria Gallo and Felice Scala and Simona Losito and Vincenza Granata and Marco Cascella and Stefano Greggi",
year = "2016",
month = "11",
day = "1",
doi = "10.1097/IGC.0000000000000825",
language = "English",
volume = "26",
pages = "1650--1657",
journal = "International Journal of Gynecological Cancer",
issn = "1048-891X",
publisher = "Lippincott Williams and Wilkins",
number = "9",

}

TY - JOUR

T1 - Long-Term Oncologic and Reproductive Outcomes in Young Women with Early Endometrial Cancer Conservatively Treated

T2 - A Prospective Study and Literature Update

AU - Laurelli, Giuseppe

AU - Falcone, Francesca

AU - Gallo, Maria

AU - Scala, Felice

AU - Losito, Simona

AU - Granata, Vincenza

AU - Cascella, Marco

AU - Greggi, Stefano

PY - 2016/11/1

Y1 - 2016/11/1

N2 - Objective This study aimed to analyze the long-term oncologic and reproductive outcomes in endometrial cancer (EC) in young patients conservatively treated by combined hysteroscopic resection (HR) and levonorgestrel intrauterine device (LNG-IUD). Methods Twenty-one patients (age ≤ 40 years; Stage IA, G1-2 endometrioid EC), wishing to preserve their fertility, were enrolled into this prospective study. The HR was used to resect (1) the tumor lesion, (2) the endometrium adjacent to the tumor, and (3) the myometrium underlying the tumor. Hormonal therapy consisted of LNG-IUD (52 mg) for at least 6 months. Results The median follow-up time is 85 months (range, 30-114). After 3 months from the progestin start date, 18 patients (85.7%) showed a complete regression (CR), 2 (9.5%) showed persistent disease, whereas 1 patient (4.8%) presented with progressive disease and underwent definitive surgery (Stage IA, G3 endometrioid). At 6 months, 1 of the 2 persistences underwent definitive surgery (Stage IA, G1 endometrioid), whereas the other was successfully re-treated. Two recurrences (10.5%) were observed, both involving the endometrium and synchronous ovarian cancer (OC) (atypical hyperplasia and Stage IIB G1 endometrioid OC; Stage IA endometrioid G1 EC, and Stage IA G1 endometrioid OC). The median duration of complete response was 85 months (range, 8-117). Sixty-three percent of complete responders attempted to conceive with 92% and 83% pregnancy and live birth rates, respectively. To date, all patients are alive and have no evidence of disease. Conclusions After a long follow-up, combined HR and LNG-IUD would seem to improve the efficacy of progestin alone. High pregnancy and live birth rates were observed in women attempting to conceive. This approach is still experimental and should be offered only in the framework of scientific protocols conducted in cancer centers.

AB - Objective This study aimed to analyze the long-term oncologic and reproductive outcomes in endometrial cancer (EC) in young patients conservatively treated by combined hysteroscopic resection (HR) and levonorgestrel intrauterine device (LNG-IUD). Methods Twenty-one patients (age ≤ 40 years; Stage IA, G1-2 endometrioid EC), wishing to preserve their fertility, were enrolled into this prospective study. The HR was used to resect (1) the tumor lesion, (2) the endometrium adjacent to the tumor, and (3) the myometrium underlying the tumor. Hormonal therapy consisted of LNG-IUD (52 mg) for at least 6 months. Results The median follow-up time is 85 months (range, 30-114). After 3 months from the progestin start date, 18 patients (85.7%) showed a complete regression (CR), 2 (9.5%) showed persistent disease, whereas 1 patient (4.8%) presented with progressive disease and underwent definitive surgery (Stage IA, G3 endometrioid). At 6 months, 1 of the 2 persistences underwent definitive surgery (Stage IA, G1 endometrioid), whereas the other was successfully re-treated. Two recurrences (10.5%) were observed, both involving the endometrium and synchronous ovarian cancer (OC) (atypical hyperplasia and Stage IIB G1 endometrioid OC; Stage IA endometrioid G1 EC, and Stage IA G1 endometrioid OC). The median duration of complete response was 85 months (range, 8-117). Sixty-three percent of complete responders attempted to conceive with 92% and 83% pregnancy and live birth rates, respectively. To date, all patients are alive and have no evidence of disease. Conclusions After a long follow-up, combined HR and LNG-IUD would seem to improve the efficacy of progestin alone. High pregnancy and live birth rates were observed in women attempting to conceive. This approach is still experimental and should be offered only in the framework of scientific protocols conducted in cancer centers.

KW - Endometrial cancer

KW - Fertility preservation

KW - Hormonal therapy

KW - Hysteroscopic surgery

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