Hysteroscopic Endometrial Focal Resection followed by Levonorgestrel Intrauterine Device Insertion as a Fertility-Sparing Treatment of Atypical Endometrial Hyperplasia and Early Endometrial Cancer: A Retrospective Study

Autor: Antonio Travaglino, Giuseppe De Placido, Antonio Raffone, Antonio Boccellino, Fulvio Zullo, Pierluigi Giampaolino, Luigi Insabato, Brunella Zizolfi, Giuseppe Bifulco, Antonio Mollo, Attilio Di Spiezio Sardo
Přispěvatelé: Giampaolino, P., Di Spiezio Sardo, A., Mollo, A., Raffone, A., Travaglino, A., Boccellino, A., Zizolfi, B., Insabato, L., Zullo, F., De Placido, G., Bifulco, G.
Rok vydání: 2019
Předmět:
Conservative
Endometrioid adenocarcinoma
Progestogen
Recurrence
Regression
Adult
Carcinoma
Endometrioid
Endometrial Hyperplasia
Endometrial Neoplasms
Endometrium
Female
Fertility
Fertility Preservation
Humans
Intrauterine Devices
Medicated
Italy
Levonorgestrel
Neoplasm Recurrence
Local
Pregnancy
Retrospective Studies
Treatment Outcome
Young Adult
Organ Sparing Treatments
0302 clinical medicine
Stage (cooking)
Atypical Endometrial Hyperplasia
030219 obstetrics & reproductive medicine
Obstetrics and Gynecology
Local
030220 oncology & carcinogenesis
Live birth
medicine.drug
Endometrioid
medicine.medical_specialty
Subsequent Relapse
Intrauterine device
03 medical and health sciences
medicine
business.industry
Endometrial cancer
Carcinoma
Retrospective cohort study
medicine.disease
Surgery
Neoplasm Recurrence
Medicated
business
Intrauterine Devices
Zdroj: Journal of Minimally Invasive Gynecology. 26:648-656
ISSN: 1553-4650
Popis: Study Objective To evaluate safety and effectiveness of the combination of hysteroscopic endometrial focal resection with levonorgestrel-releasing intrauterine device (LNG-IUD) for International Federation of Gynecology and Obstetrics stage IA G1 early endometrial cancer (EEC) and atypical endometrial hyperplasia (AEH) in young women to preserve their fertility. Design Retrospective case series (Canadian Task Force classification II-3). Setting University Federico II, Naples, Italy. Patients The medical records of 69 consecutive patients treated from 2007 to 2017 with diagnosis of EEC (n = 14) or AEH (n = 55) meeting inclusion criteria were reviewed. Interventions Patients with focal EEC were treated by hysteroscopic resection of the lesion according to Mazzon's technique; patients with AEH were treated by superficial endometrial resection, preserving the basal layer of the endometrium. An LNG-IUD was inserted in all patients after surgery. Patients were followed for 24 months with serial hysteroscopic biopsies. Measurements and Main Results Rates of response, live birth, and recurrence were assessed. Of the 14 patients with EEC, 11 (78.6%) achieved a complete response, 2 (18.2%) of whom had subsequent relapse, 1 (7.1%) showed partial response, whereas 2 (14.3%) were nonresponders (1 stable disease and 1 progression). Of the 55 patients with AEH, 51 (92.7%) achieved a complete response, 2 (3.9%) of whom had subsequent relapse, 3 (5.5%) showed partial response, whereas only 1 (1.8%) was nonresponder with stable disease. Among 25 patients who had removed the LNG-IUD, 10 (40%) gave birth after natural conception in the last 12 months of follow-up. Conclusion The combination of hysteroscopic resection with an LNG-IUD as fertility-sparing treatment of EEC and AEH showed similar response and live birth rates compared with those reported in literature for progestins alone, but with considerably lower relapse rate. We advocate the use of this combined approach as an alternative fertility-sparing option in patients with ECC and AEH.
Databáze: OpenAIRE
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