Live births and maintenance with levonorgestrel IUD improve disease-free survival after fertility-sparing treatment of atypical hyperplasia and early endometrial cancer

Новикова, О В; Nosov, V; Panov, Vladimir; Новикова, Е. Г.; Krasnopolskaya, K. V.; Andreeva, Yu Yu; Шевчук, А. С.

doi:10.1016/j.ygyno.2021.01.001

Cited by 37 publications

(51 citation statements)

References 40 publications

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“…Analysis of possible response predictors singled out several factors: age, BMI, and weight control have been reported as factors predictive of remission and recurrence in previous reports. Age at diagnosis was a significant contributor to remission rate in women younger than 35 years as opposed to patients of 35 years of age and older (24), which was also found in our research. Besides, patients who were obese and lose weight <10% have a lower response and pregnancy rates, as well as higher recurrence rates, consistent with previous studies (25).…”

Section: Discussionsupporting

confidence: 89%

“…We change the regimen from progestin to GnRHa in this patient when we notice this phenomenon, and she finally achieved CR after three courses. The status of PR and estrogen receptor (ER) was thought to be associated with disease regression in some research, and the weak expression of PR-B could be a predictive factor of no response and recurrence (36)(37)(38), while others indicated that many ER-and PR-negative lesions would still respond to hormonal therapy, but they are against routine ER and PR tissue expression testing, as this does not change the management plan (24,28). But we believe that GnRHa combined therapy might be an option for the patient who is PR negative instead of progestin.…”

Section: Discussionmentioning

confidence: 99%

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Management of Recurrent Endometrial Cancer or Atypical Endometrial Hyperplasia Patients After Primary Fertility-Sparing Therapy

et al. 2021

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ObjectiveTo evaluate the efficacy and prognosis of fertility-sparing re-treatment on patients with recurrent endometrial cancer (EC) and atypical endometrial hyperplasia (AEH) who wish to preserve their uterus after complete remission (CR) for primary conservative therapy.MethodsWe performed a retrospective study on recurrent EC or AEH patients who received fertility-sparing re-treatment after achieving CR. Data regarding clinicopathological factors, adverse events, treatment efficacy, tumor prognosis, and reproductive outcome were analyzed.ResultsOf the 98 recurrent patients with a median disease-free interval period of 19 (3–96) months, 18 patients decided to receive hysterectomy directly, and 80 patients received fertility-preserving re-treatment. Seventy-one (88.6%) cases achieved CR, 96.0% in AEH and 75.8% in EC patients, with the 6 (3–16) months’ median CR time. Seven (8.8%) patients failed to achieve CR and then underwent the hysterectomy: one partial response (PR), four stable disease (SD), and two progressive disease (PD). Forty-nine women attempted to get pregnant after CR, 13 (26.5%) became pregnant, seven (14.3%) successfully delivered, and six (12.2%) miscarried. During the follow-up period, 22 (31.0%) women had developed a second relapse with the median recurrence time of 12 (4–90) months, and 10 patients decided to receive the third round of fertility-sparing treatment. Seven (70.0%) patients, 33.3% in EC and 85.7% in AEH, achieved CR again. Hysterectomy was performed in two (20.0%) patients due to SD. After the third-round treatment, six women had the desire to conceive but no one became pregnant successfully.ConclusionFor patients with recurrent EC and AEH after primary conservative treatment, fertility-preserving re-treatment can still achieve a promising response, and patients have possibilities of completing childbirth.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Management of Recurrent Endometrial Cancer or Atypical Endometrial Hyperplasia Patients After Primary Fertility-Sparing Therapy

et al. 2021

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“…The use of the LNG-IUD to treat AEH and EC appears promising [ 91 , 118 ]. Fertility-sparing treatment with LNG-IUD for patients with AEH and EC was reported to achieve high regression rates and good fertility outcomes [ 118 , 119 ]. High response rates after treatment with LNG-IUD were observed also in patients with grade 1 EEC (67%) and grade 2 EEC (75%) [ 103 ].…”

Section: Management Of Endometrial Cancermentioning

confidence: 99%

Contemporary Fertility-Sparing Management Options of Early Stage Endometrioid Endometrial Cancer in Young Nulliparous Patients

Aimagambetova

Terzić

Laganà

et al. 2021

JCM

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Incidence of endometrial cancer (EC) has been increasing in recent years, especially in high-income countries. The disease commonly affects peri- and postmenopausal women; however, about 5% of women are diagnosed with EC in their reproductive age. Due to both the increasing incidence of EC among reproductive age women and trends to delayed childbearing, fertility-sparing treatment for young patients with EC has become extremely important for researchers and practitioners. Because the classic treatment with total hysterectomy and bilateral saplingo-oophorectomy is not an appropriate approach for young women demanding fertility preservation, several fertility-sparing options have been developed and summarized in this review. Utilization of different medications and their combination (progestagens, gonadotropin releasing hormones analogues, and metformin in different formulations) are tested and found as efficient for fertility-sparing treatment. New minimally invasive surgical techniques, combined with progestagens, are also confirmed as valuable. There are many novel conservative and surgical treatment approaches under investigation. Assuming that molecular biomarkers can be both diagnostic and prognostic to assist in prediction of response to a certain therapy, prognostic risk groups’ stratification along with specific biomarkers’ identification will ensure low recurrence and decrease mortality rates in young women with EC.

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“…But some of the recurrences were diagnosed as early as 6-7 months after a CR. Another study report that recurrence occurred 3-4 months after CR which mandates the follow-up to be started early (33) . The latest recurrence in our cohort took place at 7 years in our research, others also report at 13 years (34,35) .…”

Section: Main Findingsmentioning

confidence: 99%

Gonadotropin-Releasing Hormone Agonist Based Fertility-Sparing Treatment in Women with Endometrial Carcinoma or Atypical Endometrial Hyperplasia

junyu¹,

Cao

Yang³

et al. 2021

Preprint

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Objectives：To evaluate the efficacy and safety of gonadotropin-releasing hormone agonist (GnRHa) combined with levonorgestrel-releasing intrauterine system (LNG-IUS) or aromatase inhibitor (AI) in women with endometrial carcinoma (EC) and atypical endometrial hyperplasia (AEH) who wish to preserve their fertility. Design: A single-center restrospective study. Setting: Department of Obstetrics and Gynecology, Peking Union Medical College Hospital Population：179 patients with early stage EC or AEH who wish to preserve their fertility. Methods: Patients were treated with the combination of GnRHa with LNG-IUS (group GLI: GnRHa IH every 4 weeks and LNG-IUS insertion constantly) or combination of GnRHa with AI (group GAI: GnRHa IH every 4 weeks and oral letrozole 2.5mg, daily). Histological evaluation was performed at the end of each course (every 3-4 months) by hysteroscopy and curettage. All patients were followed up regularly. Main outcome measures: Pathological response to treatmen, categorized as complete response (CR), partial response (PR), stable disease (SD), and progressive disease (PD). Results: Overall, 169 (94.4%) patients achieved CR, 96.7% in AEH and 93.3% in EC patients. The median time to CR was 6 (3-18) months, 4 (3-10) months in AEH and 8 (3-18) months in EC patients. After a median follow up of 27.5 months, 41 (24.3%) women developed recurrence with the median recurrence time of 17 (6-77) months. Of the patients with CR, 134 cases desired to conceive, and 42 (32.3%) patients became pregnant. Conclusion: GnRHa based fertility-sparing treatment achieved good treatment outcomes. Future larger multi-institutional studies should be designed to confirm these preliminary findings.

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Live births and maintenance with levonorgestrel IUD improve disease-free survival after fertility-sparing treatment of atypical hyperplasia and early endometrial cancer

Cited by 37 publications

References 40 publications

Management of Recurrent Endometrial Cancer or Atypical Endometrial Hyperplasia Patients After Primary Fertility-Sparing Therapy

Management of Recurrent Endometrial Cancer or Atypical Endometrial Hyperplasia Patients After Primary Fertility-Sparing Therapy

Contemporary Fertility-Sparing Management Options of Early Stage Endometrioid Endometrial Cancer in Young Nulliparous Patients

Gonadotropin-Releasing Hormone Agonist Based Fertility-Sparing Treatment in Women with Endometrial Carcinoma or Atypical Endometrial Hyperplasia

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