Progestin Intrauterine Device in an Adolescent With Grade 2 Endometrial Cancer

Brown, Alaina J.; Westin, Shannon N.; Broaddus, Russell R.; Schmeler, Kathleen M.

doi:10.1097/aog.0b013e318234d97c

Cited by 40 publications

(39 citation statements)

References 11 publications

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“…Sometimes, however, patients with superficial myometrial invasion and/orgrade 2-3 disease may want to preserve their fertility. Only a few studies have reported the outcomes of fertility-sparing treatment in patients with stage IA, grade 2-3 disease without myometrial invasion as a part of their wider analyses (Table 2) [19, 51,[103][104][105][106][107]. Recently, Park et al [12] reported the oncologic and reproductive outcomes in a cohort of endometrial cancer patients with superficial myometrial invasion and/orgrade 2-3 disease.…”

Section: Progestin Therapy For More Advanced Diseasementioning

confidence: 99%

Progestins in the Fertility-Sparing Treatment and Retreatment of Patients With Primary and Recurrent Endometrial Cancer

Nam

2015

The Oncologist

109

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Endometrial cancer is the most common gynecologic cancer in developed countries. Approximately 3%-14% of endometrial cancers are diagnosed in young women under 40 who want to preserve their fertility. The incidence of endometrial cancer in this age group is increasing, for which fertility-sparing therapy is increasingly used because it is one of the most important quality of life issues in these women. Progestin therapy is the most common type of fertility-sparing therapy. In this review, the most up-to-date findings regarding fertility-sparing progestin therapy for young women with primary and recurrent endometrial cancer is addressed in terms of diagnosis, treatment, follow-up, and oncologic and reproductive outcomes. Fertility-sparing progestin therapy is highly effective in selected young women with primary and recurrent endometrial cancer. The selection of appropriate patients through comprehensive pretreatment evaluation is of paramount importance to achieve the best outcomes without compromising survival. Because of the high rate of recurrence after successful fertility-sparing therapy, close surveillance is mandatory, and prophylactic hysterectomy is the best option for patients who have completed family planning. Pregnancy outcomes are very promising with the aid of assisted reproductive technologies. Continuous daily oral medroxyprogesterone acetate and megestrol acetate are the preferred progestins for fertility-sparing therapy, but future studies should be performed to determine the optimal dose and treatment duration of these agents. The Oncologist 2015; 20:270-278 Implications for Practice: In young women with endometrial cancer, the cure rate is very high.Therefore, the efficacy of treatment should not be limited to the oncologic outcomes.The quality-of-life issue is as important as oncologic outcomes in these patients. Fertility preservation is one of the most important quality-of-life issues. Based on the results of numerous studies, fertility-sparing progestin therapy can be safely performed in endometrioid adenocarcinoma confined to the endometrium. It also can be reasonably recommended to selected women with more advanced disease and recurrent disease. However, careful follow-up is important because of the high rate of recurrence.

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Section: Progestin Therapy For More Advanced Diseasementioning

confidence: 99%

Progestins in the Fertility-Sparing Treatment and Retreatment of Patients With Primary and Recurrent Endometrial Cancer

Nam

2015

The Oncologist

109

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“…For patients who are contraindicated to receive oral progestin or those with complaints of systemic side effects, LNG-IUS, which works locally in the endometrium, can be used. Recent studies have reported that combination treatment shows better results than single LNG-IUS treatment [89101112131819]. In particular, Kim et al [28] conducted a prospective observational study where MPA 500 mg/day and LNG-IUS were used in 16 patients with early-stage EC and reported that complete remission without any particular side effect was observed in 14 of 16 patients.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, studies should investigate other diagnostic tools that can substitute for D&C, with less invasiveness and less risk of injuring the endometrium. Several studies investigated the accuracy of EM aspiration biopsy conducted without LNG-IUS removal after treating EC with LNG-IUS [910111213181920]. However, no study has evaluated the accuracy of EM aspiration biopsy after LNG-IUS removal in EC patients treated with high-dose progesterone and LNG-IUS therapy, and whether it can substitute for D&C. This study aimed to compare the accuracy of EM aspiration biopsy conducted after LNG-IUS removal and D&C biopsy in order to evaluate the treatment responses of patients with early EC conservatively treated with high-dose oral progestin and LNG-IUS, and its usefulness.…”

Section: Introductionmentioning

confidence: 99%

Dilatation and curettage is more accurate than endometrial aspiration biopsy in early-stage endometrial cancer patients treated with high dose oral progestin and levonorgestrel intrauterine system

et al. 2017

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ObjectiveTo determine whether less invasive endometrial (EM) aspiration biopsy is adequately accurate for evaluating treatment outcomes compared to the dilatation and curettage (D&C) biopsy in early-stage endometrial cancer (EC) patients treated with high dose oral progestin and levonorgestrel intrauterine system (LNG-IUS).MethodsWe conducted a prospective observational study with patients younger than 40 years who were diagnosed with clinical stage IA, The International Federation of Gynecology and Obstetrics grade 1 or 2 endometrioid adenocarcinoma and sought to maintain their fertility. The patients were treated with medroxyprogesterone acetate 500 mg/day and LNG-IUS. Treatment responses were evaluated every 3 months. EM aspiration biopsy was conducted after LNG-IUS removal followed D&C. The tissue samples were histologically compared. The diagnostic concordance rate of the two tests was examined with κ statistics.ResultsTwenty-eight pairs of EM samples were obtained from five patients. The diagnostic concordance rate of D&C and EM aspiration biopsy was 39.3% (κ value=0.26). Of the seven samples diagnosed as normal with D&C, three (42.8%) were diagnosed as normal by using EM aspiration biopsy. Of the eight samples diagnosed with endometrioid adenocarcinoma by using D&C, three (37.5%) were diagnosed with endometrioid adenocarcinoma by using EM aspiration biopsy. Of the 13 complex EM hyperplasia samples diagnosed with the D&C, five (38.5%) were diagnosed with EM hyperplasia by using EM aspiration biopsy. Of the samples obtained through EM aspiration, 46.4% were insufficient for histological evaluation.ConclusionTo evaluate the treatment responses of patients with early-stage EC treated with high dose oral progestin and LNG-IUS, D&C should be conducted after LNG-IUS removal.

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“…As an alternative for younger women wishing to preserve fertility, progestin-containing intrauterine devices (IUDs) have been used with reasonable safety and efficacy (21, 22), though this has predominantly been performed in patients with grade 1 disease. However, one case of grade 2 has been reported to be successfully treated (21). …”

Section: Surgical Procedures For Endometrial Cancermentioning

confidence: 99%