Prolonged Conservative Treatment of Endometrial Cancer Patients: More Than 1 Pregnancy Can Be Achieved

2011 ◽  
Vol 21 (1) ◽  
pp. 72-78 ◽  
Author(s):  
Tamar Perri ◽  
Jacob Korach ◽  
Walter H. Gotlieb ◽  
Mario Beiner ◽  
Dror Meirow ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Conservative Treatment ◽  
Early Stage ◽  
Intrauterine Device ◽  
Endometrial Adenocarcinoma ◽  
Tertiary Care ◽  
Young Patients ◽  
High Recurrence Rate ◽  
High Dose ◽  
Endometrioid Adenocarcinoma

Background:Preserving reproductive function in young patients with early endometrial cancer is an accepted concept today. The safety and feasibility of long-term conservative treatment, allowing more than 1 pregnancy, remain to be ascertained.Methods:This study was a retrospective chart review of a 27 women with endometrioid adenocarcinoma of the endometrium, who were treated conservatively at 2 tertiary-care institutions. Treatment comprised oral high-dose progestins with or without a levonorgestrel-releasing intrauterine device. Endometrial biopsy was repeated every 2 to 3 months.Results:Over 7.8 to 412 months (median, 57.4 months), tumors regressed completely in 24 (89%) of 27 patients and partially in 2 patients, with 79% responding within 1 to 17 months. Of the complete responders, 15 (62%) of 24 had a recurrence; 4 underwent hysterectomy, and 11 underwent subsequent progestational treatment. All 11 responded, and 3 subsequently conceived. After 2 to 4 years, 5 patients again had a recurrence, of whom 3 underwent hysterectomy. Overall, 2 patients developed ovarian adenocarcinoma. All patients are currently disease-free. Conception occurred in 14 (51.8%) of 27 patients, in 5 more than once. There were 17 live births, and 2 patients are pregnant.Conclusions:According to our data, prolonged progestational therapy for early-stage endometrial adenocarcinoma, allowing women to conceive, is feasible and apparently does not alter clinical outcome. Patients should be advised of the high recurrence rate and possible concomitant ovarian malignancy.

scholarly journals Clinicopathological analysis of early endometrial cancers

2016 ◽  
Author(s):  
Seema Singhal ◽  
Sunesh Kumar Jain ◽  
D. N. Sharma ◽  
Sandeep Mathur ◽  
Juhi Bharti ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Early Stage ◽  
Endometrial Adenocarcinoma ◽  
Tertiary Care ◽  
Myometrial Invasion ◽  
Poor Correlation ◽  
Histopathological Analysis ◽  
Peritoneal Cytology ◽  
Type I ◽  
Positive Peritoneal Cytology

Aim: The study objectives were evaluation of clinicopathological characteristics, correlations between the preoperative and postoperative tumor assessment in early stage endometrial cancer. Materials and Methods: We conducted a prospective descriptive study of 30 cases of endometrial cancer stage 1 examined and treated at a tertiary care teaching institute between the years 2014-15. Results: The patients’ mean age at the time of diagnosis was 56.4 years. The mean parity was two. Postmenopausal bleeding with or without abnormal vaginal discharge was the most frequent symptom; it was present in 84.7% of patients. Co morbidities like hypertension and diabetes were seen in 65% of women. 6/30 patients had family history of some malignancy. All the patients underwent Type I extrafascial hysterectomy with bilateral salpingo oophorectomy, one case had Type I extrafascial hysterectomy with infracolic omentectomy. A total of 10.6% cases had lymph nodes metastasis and none of these patients had ovarian metastasis or positive peritoneal cytology. None of the patients with superficial myometrial invasion (MI) had lymph node metastasis. None of the cases showed positive peritoneal cytology. Staging upgraded fom 1a to 1b in 50% of subjects after final histopathological analysis. One patient who was operated as endometrial hyperplasia with atypia actually had endometrial adenocarcinoma in the postoperative specimen. Conclusions: There is a poor correlation between the preoperative and the postoperative tumor assessment.

Conservative Treatment With Progestin and Pregnancy Outcomes in Endometrial Cancer

2009 ◽  
Vol 19 (6) ◽  
pp. 1068-1073 ◽  
Author(s):  
Ho-Suap Hahn ◽  
Seok-Geun Yoon ◽  
Jae-Shik Hong ◽  
Sung-Ran Hong ◽  
Sei-Jin Park ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Complete Remission ◽  
Conservative Treatment ◽  
Median Time ◽  
Pregnancy Outcomes ◽  
Partial Remission ◽  
Early Stage ◽  
Endometrial Adenocarcinoma ◽  
Persistent Disease ◽  
Dilation And Curettage

Introduction:The purpose of this study was to evaluate the efficacy of conservative treatment with progestin and pregnancy outcomes in women with early-stage endometrial cancer.Methods:We retrospectively analyzed the medical records of 35 patients with endometrial adenocarcinoma, who were treated with progestin from January 1996 to December 2006. Women with early-stage grade 1 endometrioid endometrial adenocarcinoma, who wanted to receive conservative treatment or preserve fertility, were included. All women were treated with medroxyprogesterone acetate or megestrol acetate, with regular dilation and curettage performed. Complete remission (CR) was defined as no evidence of endometrial adenocarcinoma or hyperplasia. Partial remission was diagnosed when the patient developed endometrial hyperplasia, and persistent disease was defined as residual endometrial adenocarcinoma by pathologic confirmation.Results:The median age was 31 years (range, 21-43 years), and the median follow-up period was 39 months (range, 5-108 months). Complete remission was achieved in 22 patients (62.9%), partial remission was achieved in 1 patient (2.9%), and 12 patients (34.3%) had persistent disease. The median time to CR was 9 months (range, 2-12 months). Of the 22 patients with CR, 9 (40.9%) had recurrent disease, and the median time to recurrence was 12 months (range, 8-48 months). Ten (83.3%) of the 12 patients with CR who tried to conceive were successful, and 8 of the 10 pregnancies resulted in live births. There were no congenital anomalies in babies associated with progestin treatment.Conclusions:Conservative treatment with progestin can be considered a good therapeutic option in patients with well-differentiated early-stage endometrioid endometrial adenocarcinoma who wish to preserve their uteri or become pregnant.

scholarly journals Endometrial Carcinoma in a 26-Year-Old Patient with Bardet-Biedl Syndrome

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Olga Grechukhina ◽  
Gregory M. Gressel ◽  
William Munday ◽  
Serena Wong ◽  
Alessandro Santin ◽  
...  
Keyword(s):  
Risk Factors ◽  
Endometrial Cancer ◽  
Endometrial Adenocarcinoma ◽  
Clinical Signs ◽  
Young Patients ◽  
Abnormal Uterine Bleeding ◽  
Uterine Bleeding ◽  
Endometrioid Adenocarcinoma ◽  
Bardet Biedl Syndrome ◽  
Obesity And Diabetes

Background. Bardet-Biedl Syndrome (BBS) is a rare genetic condition characterized by cognitive impairment, dysmorphism, central obesity, and diabetes mellitus, among other abnormalities. Although some of these characteristics are known independent risk factors for endometrial cancer and its precursors, the association between BBS and endometrial cancer is underreported. Case. We present the case of a 26-year-old patient with BBS and clinical signs of hyperestrogenism who presented with abnormal uterine bleeding and was diagnosed with endometrioid adenocarcinoma. She ultimately underwent definitive surgical treatment with hysterectomy and bilateral salpingectomy. Conclusions. This is one of only a few reports in the literature describing the association of BBS and endometrioid endometrial adenocarcinoma. Given the association of BBS with risk factors for hyperestrogenism such as truncal obesity, hyperinsulinemia, and ovulatory dysfunction, providers should have increased suspicion for endometrial cancer in young patients with BBS and abnormal uterine bleeding.

scholarly journals Clinicopathological analysis of early endometrial cancers

2016 ◽  
Author(s):  
Seema Singhal ◽  
Sunesh Kumar Jain ◽  
D. N. Sharma ◽  
Sandeep Mathur ◽  
Juhi Bharti ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Early Stage ◽  
Endometrial Adenocarcinoma ◽  
Tertiary Care ◽  
Myometrial Invasion ◽  
Poor Correlation ◽  
Histopathological Analysis ◽  
Peritoneal Cytology ◽  
Type I ◽  
Positive Peritoneal Cytology

Aim: The study objectives were evaluation of clinicopathological characteristics, correlations between the preoperative and postoperative tumor assessment in early stage endometrial cancer. Materials and Methods: We conducted a prospective descriptive study of 30 cases of endometrial cancer stage 1 examined and treated at a tertiary care teaching institute between the years 2014-15. Results: The patients’ mean age at the time of diagnosis was 56.4 years. The mean parity was two. Postmenopausal bleeding with or without abnormal vaginal discharge was the most frequent symptom; it was present in 84.7% of patients. Co morbidities like hypertension and diabetes were seen in 65% of women. 6/30 patients had family history of some malignancy. All the patients underwent Type I extrafascial hysterectomy with bilateral salpingo oophorectomy, one case had Type I extrafascial hysterectomy with infracolic omentectomy. A total of 10.6% cases had lymph nodes metastasis and none of these patients had ovarian metastasis or positive peritoneal cytology. None of the patients with superficial myometrial invasion (MI) had lymph node metastasis. None of the cases showed positive peritoneal cytology. Staging upgraded from 1a to 1b in 50% of subjects after final histopathological analysis. One patient who was operated as endometrial hyperplasia with atypia actually had endometrial adenocarcinoma in the postoperative specimen. Conclusions: There is a poor correlation between the preoperative and the postoperative tumor assessment.

scholarly journals Successful live birth after fertility-sparing treatment in grade II endometrial cancer: A case report

2020 ◽  
Vol 55 (1) ◽  
pp. 36-38
Author(s):  
E. K. KUKUBASSOV ◽  
R. O. BOLATBEKOVA ◽  
A. R. SATANOVA ◽  
O. O. BERTLEUOV ◽  
D. B. KALDYBEKOV ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Hormone Therapy ◽  
Young Women ◽  
Early Stage ◽  
Intrauterine Device ◽  
Young Patients ◽  
Complete Response ◽  
Figo Stage ◽  
Response To Treatment ◽  
Fertility Sparing

Relevance: The growing incidence of endometrial cancer among young women urges the use of fertility-sparing therapy. The purpose of this study was to demonstrate the results of using fertility-sparing therapy in a woman with endometrial cancer, FIGO stage IA GII. Results: After the combination hormone therapy with gonadotropin-releasing hormone (diphereline 3.75 mg every 28 days) using a hormone-releasing intrauterine device, the patient with endometrial cancer stage 1, GII demonstrated a complete response to treatment and delivered a live newborn. Conclusion: Surgery remains the primary treatment for the early stages of endometrial cancer. However, hormone therapy can preserve fertility in young women with highly differentiated early-stage endometrial cancer. The described schemes of hormone therapy can be used in young patients.

scholarly journals Successful live birth after fertility-sparing treatment in grade II endometrial cancer: A case report

2020 ◽  
Vol 55 (1) ◽  
pp. 43-46
Author(s):  
E. K. KUKUBASSOV ◽  
R. O. BOLATBEKOVA ◽  
A. R. SATANOVA ◽  
O. O. BERTLEUOV ◽  
D. B. KALDYBEKOV ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Hormone Therapy ◽  
Young Women ◽  
Early Stage ◽  
Intrauterine Device ◽  
Young Patients ◽  
Complete Response ◽  
Figo Stage ◽  
Response To Treatment ◽  
Fertility Sparing

Relevance: The growing incidence of endometrial cancer among young women urges the use of fertility-sparing therapy. The purpose of this study was to demonstrate the results of using fertility-sparing therapy in a woman with endometrial cancer, FIGO stage IA GII. Results: After the combination hormone therapy with gonadotropin-releasing hormone (diphereline 3.75 mg every 28 days) using a hormone-releasing intrauterine device, the patient with endometrial cancer stage 1, GII demonstrated a complete response to treatment and delivered a live newborn. Conclusion: Surgery remains the primary treatment for the early stages of endometrial cancer. However, hormone therapy can preserve fertility in young women with highly differentiated early-stage endometrial cancer. The described schemes of hormone therapy can be used in young patients.

scholarly journals Adjuvant brachytherapy for FIGO stage I serous or clear cell endometrial cancer

2021 ◽  
pp. ijgc-2020-002217
Author(s):  
Elizabeth B Jeans ◽  
William G Breen ◽  
Trey C Mullikin ◽  
Brittany A Looker ◽  
Andrea Mariani ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Clear Cell ◽  
Early Stage ◽  
Figo Stage ◽  
Stage I ◽  
High Dose ◽  
Vaginal Cuff ◽  
Locoregional Failure ◽  
Platinum Based Chemotherapy ◽  
Increased Risk

ObjectivesOptimal adjuvant treatment for early-stage clear cell and serous endometrial cancer remains unclear. We report outcomes for women with surgically staged International Federation of Gynecology and Obstetrics (FIGO) stage I clear cell, serous, and mixed endometrial cancers following adjuvant vaginal cuff brachytherapy with or without chemotherapy.MethodsFrom April 1998 to January 2020, women with FIGO stage IA–IB clear cell, serous, and mixed endometrial cancer underwent surgery and adjuvant vaginal cuff brachytherapy. Seventy-six patients received chemotherapy. High-dose rate vaginal cuff brachytherapy was planned to a total dose of 21 gray in three fractions using a multichannel vaginal cylinder. The primary objective was to determine the effectiveness of adjuvant vaginal cuff brachytherapy and to identify surgicopathological risk factors that could portend towards worse oncological outcomes.ResultsA total of 182 patients were included in the analysis. Median follow-up was 5.3 years (2.3–12.2). Ten-year survival was 73.3%. Five-year cumulative incidence (CI) of vaginal, pelvic, and para-aortic relapse was 1.4%, 2.1%, and 0.9%, respectively. Five-year locoregional failure, any recurrence, peritoneal relapse, and other distant recurrence was 4.4%, 11.6%, 5.3%, and 6.7%, respectively. On univariate analysis, locoregional failure was worse for larger tumors (per 1 cm) (HR 1.9, 95% CI 1.2 to 3.0, p≤0.01). Any recurrence was worse for tumors of at least 3.5 cm (HR 3.8, 95% CI 1.3 to 11.7, p=0.02) and patients with positive/suspicious cytology (HR 4.4, 95% CI 1.5 to 12.4, p≤0.01). Ten-year survival for tumors of at least 3.5 cm was 56.9% versus 86.6% for those with smaller tumors (HR 2.9, 95% CI 1.4 to 5.8, p≤0.01). Ten-year survival for positive/suspicious cytology was 50.9% versus 77.4% (HR 2.2, 95% CI 0.9 to 5.4, p=0.09). Multivariate modeling demonstrated worse locoregional failure, any recurrence, and survival with larger tumors, as well as any recurrence with positive/suspicious cytology. Subgroup analysis demonstrated improved outcomes with the use of adjuvant chemotherapy in patients with large tumors or positive/suspicious cytology.ConclusionAdjuvant vaginal cuff brachytherapy alone without chemotherapy is an appropriate treatment for women with negative peritoneal cytology and small, early-stage clear cell, serous, and mixed endometrial cancer. Larger tumors or positive/suspicious cytology are at increased risk for relapse and worse survival, and should be considered for additional upfront adjuvant treatments, such as platinum-based chemotherapy.

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