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

International Journal of Gynecological Cancer - Tập 26 Số 9 - Trang 1650-1657 - 2016
Giuseppe Laurelli1, Francesca Falcone, Maria Stella Gallo, Felice Scala, Simona Losito, Vincenza Granata, Marco Cascella, Stefano Greggi2
1Gynecologic Oncology Surgery, Istituto Nazionale Tumori “Fondazione G. Pascale”-IRCCS
2MD, PhD, Gynecologic Oncology Surgery, National Cancer Institute of Naples-IRCCS “Fondazione G. Pascale”, Via M. Semmola, 80131 Naples, Italy. E-mail: s.greggi{at}istitutotumori.na.it.

Tóm tắt

ObjectiveThis 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).MethodsTwenty-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.ResultsThe 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.ConclusionsAfter 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.

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Tài liệu tham khảo

Lee, 2007, Obstet Gynecol, 109, 655, 10.1097/01.AOG.0000255980.88205.15

Tomao, 2016, Crit Rev Oncol Hematol, 97, 206, 10.1016/j.critrevonc.2015.08.024

Colombo, 2015, Radiother Oncol, 117, 559, 10.1016/j.radonc.2015.11.013

Lajer, 2012, Acta Obstet Gynecol Scand, 91, 976, 10.1111/j.1600-0412.2012.01438.x

Chen, 2016, Int J Gynaecol Obstet, 132, 34, 10.1016/j.ijgo.2015.06.046

Park, 2013, Eur J Cancer, 49, 868, 10.1016/j.ejca.2012.09.017

Ushijima, 2007, J Clin Oncol, 25, 2798, 10.1200/JCO.2006.08.8344

Arendas, 2015, J Minim Invasive Gynecol, 22, 34, 10.1016/j.jmig.2014.08.782

De Marzi, 2015, J Minim Invasive Gynecol, 22, 1178, 10.1016/j.jmig.2015.06.004

Wang, 2015, Int J Clin Exp Med, 8, 13804

Marton, 2014, J Turk Ger Gynecol Assoc, 15, 63, 10.5152/jtgga.2013.69379

Shan, 2013, Arch Gynecol Obstet, 288, 1115, 10.1007/s00404-013-2826-8

Laurelli, 2011, Gynecol Oncol, 120, 43, 10.1016/j.ygyno.2010.10.004

Mazzon, 2010, Fertil Steril, 93, 1286, 10.1016/j.fertnstert.2008.12.009

Park, 2015, Oncologist, 20, 270, 10.1634/theoncologist.2013-0445

Leitao, 2009, Gynecol Oncol, 113, 105, 10.1016/j.ygyno.2008.12.017

Obermair, 2000, Cancer, 88, 139, 10.1002/(SICI)1097-0142(20000101)88:1<139::AID-CNCR19>3.0.CO;2-U

Chang, 2011, Fertil Steril, 96, 957, 10.1016/j.fertnstert.2011.07.1146

Kinkel, 1999, Radiology, 212, 711, 10.1148/radiology.212.3.r99au29711

Eriksson, 2015, Ultrasound Obstet Gynecol, 45, 476, 10.1002/uog.14645

Lu, 2007, J Clin Oncol, 25, 5158, 10.1200/JCO.2007.10.8597

Evans-Metcalf, 1998, Obstet Gynecol, 91, 349, 10.1016/S0029-7844(97)00668-6

Gitsch, 1995, Obstet Gynecol, 85, 504, 10.1016/0029-7844(95)00001-8

Song, 2013, Gynecol Oncol, 131, 624, 10.1016/j.ygyno.2013.09.009

Williams, 2009, Obstet Gynecol, 113, 783, 10.1097/AOG.0b013e31819c7bdf

Walsh, 2005, Obstet Gynecol, 106, 693, 10.1097/01.AOG.0000172423.64995.6f

Morice, 2005, Gynecol Oncol, 96, 245, 10.1016/j.ygyno.2004.09.034

Park, 2013, Obstet Gynecol, 122, 7, 10.1097/AOG.0b013e3182964ce3

Koskas, 2011, Anticancer Res, 31, 3047

Baker, 2012, Gynecol Oncol, 125, 263, 10.1016/j.ygyno.2011.11.043

Gunderson, 2012, Gynecol Oncol, 125, 477, 10.1016/j.ygyno.2012.01.003

Gallos, 2012, Am J Obstet Gynecol, 207, 266.e1, 10.1016/j.ajog.2012.08.011

Cormio, 2006, Int J Gynecol Cancer, 16, 2044, 10.1111/j.1525-1438.2006.00730.x

Ferrandina, 2005, Gynecol Oncol, 99, 215, 10.1016/j.ygyno.2005.05.025

Ota, 2005, Int J Gynecol Cancer, 15, 657, 10.1111/j.1525-1438.2005.00129.x

Park, 2013, Gynecol Oncol, 129, 7, 10.1016/j.ygyno.2012.12.037

Perri, 2011, Int J Gynecol Cancer, 21, 72, 10.1097/IGC.0b013e31820003de

Park, 2013, Obstet Gynecol, 121, 136, 10.1097/AOG.0b013e31827a0643

Creutzberg, 2013, Int J Gynecol Cancer, 23, 1528, 10.1097/IGC.0b013e3182a26edb

Thông tin
Thông tin xuất bản

International Journal of Gynecological Cancer

Tập 26 Số 9

1650-1657

Thông tin tác giả