Possibilities of reproduction after treatment for early endometrial cancer


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Abstract

Objective. To investigate whether early endometrial cancer can be treated and whether fertility can be preserved in young women, by using a hormonal combination: levonorgestrel intrauterine hormonal system (LNG-IUS; Mirena 52 mg of LH) and gonadotropin-releasing hormone agonists (Zoladex 3.6 mg). Subjects and methods. The investigation covered 79 patients. The case histories of 37 patients with atypical hyperplasia and 42 with stage I A (T1aNxMo) endometrial cancer were analyzed. The patients’ mean age was 33 years. The investigation was conducted at the Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of the Russian Federation. Results. Primary treatment was completed in 67 (84.8%) patients and in 12 (15.2%) during hormonal treatment. After completion of special treatment, 8 (11.9%) of the 67 women had 10 pregnancies that resulted in childbirth and spontaneous miscarriage in 8 and 2 cases, respectively. Recurrences and incurable disease were stated in 3 (4.2%) and 9 (12.8%) cases, respectively. Repeated hormone therapy cycles were not performed because the patients had refused organ-sparing treatment. All the 12 (17.1%) patients were successfully operated on. Conclusion. The proposed treatment regimen is a highly effective medical treatment in patients with precancer and early endometrial cancer. Independent hormone therapy is undoubtedly the best alternative to hysterectomy today in this group of patients who want to preserve reproductive function.

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About the authors

Stanislav M. Pronin

National Medical Research Center of Obstetrics, Gynecology, and Perinatology named after Academician V.I. Kulakov

MD, Oncologist, Obstetrician-Gynecologist, Senior Researcher, Department of Innovative Oncology and Gynecology

Irina A. Matsneva

I.M. Sechenov First Moscow State Medical University (Sechenov University)

a 5th year student

Elena G. Novikova

P.A. Herzen Moscow Research Institute of Oncology - a branch of the Scientific Medical Research Radiological Center

Email: egnov@bk.ru
MD, professor, head of the gynecological department of tumors of the reproductive and urinary organs

References

  1. Каприн А.Д., Старинский В.В., Петрова Г.В., ред. Злокачественные новообразования в России в 2016 году (заболеваемость и смертность). М.: МНИОИ им. П.А. Герцена - филиал ФГБУ «НМИЦ радиологии» Минздрава России; 2018: 12.
  2. Edometrial Cancer Treatment (PDQ®). National Cancer Institute; 23 April 2014. Archived from the original on 3 September 2014. Retrieved 3 September2014.
  3. Jamison P.M., Altekruse S.F., Chang J.T., Zahn J., Lee R., Noone A.M., Barroilhet L. Site-specific factors for cancer of the corpus uteri from SEER registries: collaborative stage data collection system, version 1 and version 2. Cancer. 2014; 120(Suppl. 23): 3836-45.
  4. Soliman P.T., Lu K.H. Neoplastic diseases of the uterus. In: Lentz G.M., Lobo R.A., Gershenson D.M., Katz V.L. Comprehensive gynecology. 6th ed. Philadelphia: Mosby Elsevier; 2013.
  5. Ашрафян Л.А., Киселев В.И. Опухоли репродуктивных органов (этиология и патогенез). М.; 2007.
  6. American College of Nurse-Midwives. Endometrial biopsy. J. Midwifery Womens Health. 2017; 62(4): 502-6.
  7. Daud S., Jalil S.S., Griffn M., Ewies A.A. Endometrial hyperplasia - the dilemma of management remains: a retrospective observational study of 280 women. Eur. J. Obstet. Gynecol. Reprod. Biol. 2011; 159(1): 172-5.
  8. Ашрафян Л.А., Антонова И.Б. Ранняя диагностика рака эндометрия и яичников. Практическая онкология. 2009; 10(2): 71.
  9. Laas E., Ballester M., Cortez A., Gonin J., Canlorbe G., Daraï E., Graesslin O. Supervised clustering of immunohistochemical markers to distinguish atypical and non-atypical endometrial hyperplasia. Gynecol. Endocrinol. 2015; 31(4): 282-5.
  10. Stoenescu V.E., Niculescu M., Novac L., Manolea M.M., Tomescu P.I., Dijmärescu A.L. et al. Immunohistochemical reaction of the glandular epithelium in endometrial hyperplasia compared to endometrial carcinoma. Rom. J. Morphol. Embryol. 2017; 58(3): 791-800.
  11. Loiacono R.M., Trojano G., Del Gaudio N., Kardhashi A., Deliso M.A., Falco G. et al. Hysteroscopy as a valid tool for endometrial pathology in patients with postmenopausal bleeding or asymptomatic patients with a thickened endometrium: hysteroscopic and histological results. Gynecol. Obstet. Invest. 2015; 79(3): 210-6.
  12. Gunderson C.C., Fader A.N., Carson K.A., Bristow R.E. Oncologic and reproductive outcomes with progestin therapy in women with endometrial hyperplasia and grade 1 adenocarcinoma: a systematic review. Gynecol. Oncol. 2012; 125(2): 477-82.
  13. Gonthier C., Walker F., Luton D., Yazbeck C., Madelenat P., Koskas M. Impact of obesity on the results of fertility-sparing management for atypical hyperplasia and grade 1 endometrial cancer. Gynecol. Oncol. 2014; 133: 33-7.
  14. Pal N., Broaddus R.R., Urbauer D.L., Balakrishnan N., Milbourne A., Schmeler K.M. et al. Treatment of low-risk endometrial cancer and complex atypical hyperplasia with the levonorgestrel-releasing intrauterine device. Obstet. Gynecol. 2018; 131(1): 109-16.
  15. Soliman P.T., Oh J.C., Schmeler K.M., Sun C.C., Slomovitz B.M., Gershenson D.M. et al. Risk factors for young premenopausal women with endometrial cancer. Obstet. Gynecol. 2005;105(3): 575-80.
  16. Lind J.M., Hennessy A., Chiu C.L. Association between a woman’s age at first birth and high blood pressure. Medicine (Baltimore). 2015; 94(16): e697.
  17. Новикова Е.Г., Чулкова О.В., Пронин С.М. Предрак и начальный рак эндометрия у женщин репродуктивного возраста. Монография. М.: МИА; 2005. 136с.
  18. Чернуха Г.Е., Могиревская О.А., Шигорева Т.В., Грибанова Н.Д. Клинико-морфологические аспекты внутриматочного воздействия левоноргестрела при гиперплазии эндометрия. Акушерство и гинекология. 2011; 4: 56-62.
  19. Gotlied W.H., Beiner M.E., Shalmon B., Korach Y., Segal Y., Zmira N. et al. Outcome of fertility-sparing treatment with progestins in young patients with endometrial cancer. Obstet. Gynecol. 2003; 102(4): 718-25.
  20. Niwa K., Tagami K., Lian Z., Onogi K., Mori H., Tamaya T. Outcome of fertility-preserving treatment in young women with endometrial carcinomas. BJOG. 2005; 112(3): 317-20.
  21. Perri T., Korach J., Gotlieb W.H., Beiner M., Meirow D., Friedman E. et al. Prolonged conservative treatment of endometrial cancer patients: more than 1 pregnancy can be achieved. Int. J. Gynecol. Cancer. 2011 ; 21(1): 72-8.

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