scholarly journals Gonadotropin-Releasing Hormone Agonist Based Fertility-Sparing Treatment in Women with Endometrial Carcinoma or Atypical Endometrial Hyperplasia

2021 ◽  
Author(s):  
chen junyu ◽  
Dongyan Cao ◽  
jiaxin yang ◽  
mei yu ◽  
huimei zhou ◽  
...  
Keyword(s):  
Endometrial Carcinoma ◽  
Endometrial Hyperplasia ◽  
Early Stage ◽  
Gonadotropin Releasing Hormone ◽  
Histological Evaluation ◽  
Recurrence Time ◽  
Releasing Hormone ◽  
Atypical Endometrial Hyperplasia ◽  
Gonadotropin Releasing Hormone Agonist ◽  
Fertility Sparing

Objectives：To evaluate the efficacy and safety of gonadotropin-releasing hormone agonist (GnRHa) combined with levonorgestrel-releasing intrauterine system (LNG-IUS) or aromatase inhibitor (AI) in women with endometrial carcinoma (EC) and atypical endometrial hyperplasia (AEH) who wish to preserve their fertility. Design: A single-center restrospective study. Setting: Department of Obstetrics and Gynecology, Peking Union Medical College Hospital Population：179 patients with early stage EC or AEH who wish to preserve their fertility. Methods: Patients were treated with the combination of GnRHa with LNG-IUS (group GLI: GnRHa IH every 4 weeks and LNG-IUS insertion constantly) or combination of GnRHa with AI (group GAI: GnRHa IH every 4 weeks and oral letrozole 2.5mg, daily). Histological evaluation was performed at the end of each course (every 3-4 months) by hysteroscopy and curettage. All patients were followed up regularly. Main outcome measures: Pathological response to treatmen, categorized as complete response (CR), partial response (PR), stable disease (SD), and progressive disease (PD). Results: Overall, 169 (94.4%) patients achieved CR, 96.7% in AEH and 93.3% in EC patients. The median time to CR was 6 (3-18) months, 4 (3-10) months in AEH and 8 (3-18) months in EC patients. After a median follow up of 27.5 months, 41 (24.3%) women developed recurrence with the median recurrence time of 17 (6-77) months. Of the patients with CR, 134 cases desired to conceive, and 42 (32.3%) patients became pregnant. Conclusion: GnRHa based fertility-sparing treatment achieved good treatment outcomes. Future larger multi-institutional studies should be designed to confirm these preliminary findings.

Prolonged use of gonadotropin-releasing hormone agonist and tibolone as add-back therapy for the treatment of endometrial hyperplasia

Maturitas ◽  
2004 ◽  
Vol 48 (2) ◽  
pp. 125-132 ◽  
Author(s):  
Theodoros Agorastos ◽  
Violetta Vaitsi ◽  
Minas Paschopoulos ◽  
Andromache Vakiani ◽  
Vassiliki Zournatzi-Koiou ◽  
...  
Keyword(s):  
Endometrial Hyperplasia ◽  
Gonadotropin Releasing Hormone ◽  
Releasing Hormone ◽  
Gonadotropin Releasing Hormone Agonist

scholarly journals Prevalence of Coexisting Endometrial Carcinoma in Patients with Preoperative Diagnosis of Endometrial Hyperplasia with Atypia

2020 ◽  
Vol 7 (52) ◽  
pp. 3180-3184
Author(s):  
Divya Sara Raju ◽  
Resmy C. Raveendran ◽  
Ayswariya Manivannan
Keyword(s):  
Endometrial Carcinoma ◽  
Endometrial Hyperplasia ◽  
Early Stage ◽  
Myometrial Invasion ◽  
Cross Sectional ◽  
Endometrial Sampling ◽  
Atypical Endometrial Hyperplasia ◽  
Invasion Stage ◽  
Endometrial Intraepithelial Neoplasia ◽  
Endometrial Hyperplasia With Atypia

BACKGROUND Concurrent carcinoma endometrium occurs in around 40 % of hysterectomy specimen done for premalignant endometrial intraepithelial neoplasia. We intend to study the prevalence of coexisting endometrial cancer in patients who were diagnosed with endometrial hyperplasia with atypia and had undergone hysterectomy. METHODS This cross-sectional study conducted at Government Medical College, Thrissur, included all women with a pre-operative diagnosis of endometrial hyperplasia with atypia (WHO) undergoing hysterectomy during the study period. RESULTS A total of 40 women were found to have atypical endometrial hyperplasia in the study period. The mean age of presentation was 51 ± 2. 7 yrs. and was more common in multiparous postmenopausal women. Postmenopausal bleeding was the most common presenting symptom and more than 50 % of women were overweight. The proportion of concurrent endometrial carcinoma in women with atypical endometrial hyperplasia was found to be 37. 5 %. 93 % of cases with concurrent endometrial carcinoma were of grade I endometrioid type. High risk features were defined as > 50 % myometrial invasion, seen in 47 % patients. Stage 2 endometrial carcinoma was seen in 27 % patients. 53 % patients had less than 50 % myometrial invasion. Stage 1a and 1b endometrial carcinoma was seen in 53 % and 20 % of patients respectively. CONCLUSIONS Large dicer of overlap exists between atypical endometrial hyperplasia (AEH) and early-stage endometrial carcinoma. Therefore, we should recognise the limitation of endometrial sampling in distinguishing between these two groups. KEYWORDS Atypical Endometrial Hyperplasia, Endometrial Carcinoma, Endometrial Sampling

Fertility-Sparing Treatment of Early Endometrial Cancer and Complex Atypical Hyperplasia in Young Women of Childbearing Potential

2015 ◽  
Vol 25 (6) ◽  
pp. 1010-1014 ◽  
Author(s):  
Stanislav Mikhailovich Pronin ◽  
Olga Valerievna Novikova ◽  
Julia Yurievna Andreeva ◽  
Elena Grigorievna Novikova
Keyword(s):  
Endometrial Cancer ◽  
Young Women ◽  
Hormonal Therapy ◽  
Endometrial Hyperplasia ◽  
Endometrial Adenocarcinoma ◽  
Gonadotropin Releasing Hormone ◽  
Atypical Hyperplasia ◽  
Childbearing Potential ◽  
Atypical Endometrial Hyperplasia ◽  
Gonadotropin Releasing Hormone Agonist

ObjectiveTo evaluate oncologic and reproductive outcome with levonorgestrel-releasing intrauterine system combined with gonadotropin-releasing hormone agonist in women with grade 1 endometrial carcinoma, and the levonorgestrel monotherapy in women with complex atypical hyperplasia.Materials/MethodsA prospective study was conducted. We analyzed the clinical characteristics of 70 patients younger than 42 years (mean age, 33 years) with a diagnosis of complex atypical endometrial hyperplasia (AEH) or grade 1 endometrial adenocarcinoma who were treated with hormonal therapy at the Division of Gynecologic Oncology of P.A. Hertsen Moscow Cancer Research Institute from February 2009 to December 2012. Patients with complex AEH received monotherapy with levonorgestrel-releasing intrauterine system (Mirena, Shering, Finland; 52 mg). Patients with a diagnosis of grade 1 endometrial cancer were treated with levonorgestrel-releasing intrauterine system combined with gonadotropin-releasing hormone agonist (Zoladex; AstraZeneca UK Limited, UK; 3.6-mg depot). All the patients received hormonal therapy for a minimum of 6 months. Pretreatment evaluation consisted of transabdominal and transvaginal ultrasound in grayscale, color Doppler ultrasound, contrast-enhanced magnetic resonance imaging,cervical hysteroscopy, Pipelle endometrial biopsy, and morphological and immunohistochemical characteristics of the tissue.ResultsSeventy patients were included in study analyses. Twenty three (72%) of 32 patients with adenocarcinoma and 35 (92%) of 38 patients with AEH had complete remission, defined as the absence of any carcinoma or hyperplasia on endometrial sampling specimens. Among these cases, 2 patients with adenocarcinoma and 1 patient with AEH had recurrence after their complete response. Nine patients had persistent disease. Eight patients had 10 conceptions, resulting in 8 live births.ConclusionsThe suggested conservative treatment strategy can be considered as a valid therapeutic option for young women of childbearing potential with atypical endometrial hyperplasia and grade 1 endometrial adenocarcinoma who wish to preserve their fertility and thus may be recommended as an alternative to hysterectomy. Close follow-up during and after the treatment period is strictly required.

scholarly journals Analysis of pregnancy-associated factors after fertility-sparing therapy in young women with early stage endometrial cancer or atypical endometrial hyperplasia

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Yuan Fan ◽  
Xingchen Li ◽  
Jiaqi Wang ◽  
Yiqin Wang ◽  
Li Tian ◽  
...  
Keyword(s):  
Associated Factors ◽  
Endometrial Hyperplasia ◽  
Treatment Time ◽  
Early Stage ◽  
Young Patients ◽  
Prolonged Treatment ◽  
Rank Test ◽  
Atypical Endometrial Hyperplasia ◽  
Fertility Sparing ◽  
Significant Difference

Abstract Background Fertility-sparing therapy is an alternative conservative treatment for patients with early stage endometrioid cancer or atypical endometrial hyperplasia. In this study, we investigated pregnancy outcomes and pregnancy-associated factors in young patients receiving hormonal therapy. Methods We retrospectively analyzed 68 patients who attempted to conceive after fertility-sparing therapy and achieving complete remission (CR). They were divided into a pregnancy group and a non-pregnancy group. A Cox proportional hazard regression model was applied for univariate and multivariate analysis to determine factors associated with pregnancy. Kaplan–Meier analysis, combined with the log-rank test, was used to calculate a patient’s pregnancy probability and the distribution of recurrence-free survival (RFS). Results A total of 36 patients became pregnant with 47 pregnancies. Univariate and multivariate Cox analysis revealed that several factors were associated with pregnancy, including BMI at the time of pregnancy permission, the time to CR, prolonged treatment time, the number of hysteroscopy procedures, the endometrium thickness after CR, and relapse before pregnancy. The mean RFS of patients who achieved pregnancy, and those who did not, was 27.6 months and 14.8 months, respectively (P = 0.002). No significant difference was detected in terms of cumulative RFS when compared between assisted reproductive technology (ART) cases and those involving natural conception (NC) (P = 0.707). Conclusions Normal BMI, a shorter time to CR, a prolonged three-month treatment, fewer hysteroscopy procedures, and a thicker endometrium may be positive indicators for successful pregnancies, while relapse before pregnancy may have a negative effect on conception. Moreover, a successful pregnancy protects the endometrium while ART does not increase the risk of recurrence.

Gonadotropin-Releasing Hormone Agonist Combined With a Levonorgestrel-Releasing Intrauterine System or Letrozole for Fertility-Preserving Treatment of Endometrial Carcinoma and Complex Atypical Hyperplasia in Young Women

2017 ◽  
Vol 27 (6) ◽  
pp. 1178-1182 ◽  
Author(s):  
Huimei Zhou ◽  
Dongyan Cao ◽  
Jiaxin Yang ◽  
Keng Shen ◽  
Jinghe Lang
Keyword(s):  
Endometrial Carcinoma ◽  
Young Women ◽  
Gonadotropin Releasing Hormone ◽  
Atypical Hyperplasia ◽  
Endometrioid Adenocarcinoma ◽  
Releasing Hormone ◽  
Gonadotropin Releasing Hormone Agonist ◽  
Intramuscular Injections ◽  
Well Differentiated

ObjectivesThe aim of this study was to evaluate the efficacy and safety with gonadotropin-releasing hormone agonist (GnRHa) combined with a levonorgestrel-releasing intrauterine system or an aromatase inhibitor (letrozole) in young women with well-differentiated early endometrial carcinoma (EC) and complex atypical hyperplasia (CAH).MethodsWe performed a retrospective analysis including the clinical characteristics of 29 patients younger than 45 years with early well-differentiated endometrioid adenocarcinoma of the uterus (EC) or CAH who were treated at the Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, from January 2012 to April 2016. Eighteen patients were treated with the combination of intramuscular injections of GnRHa every 4 weeks with the levonorgestrel intrauterine hormonal system (Mirena® Bayer Health Care Pharmaceutical Inc, Wayne, NY) was inserted. Eleven patients were treated with the combination of intramuscular injections of GnRHa every 4 weeks with oral letrozole 2.5 mg daily. The patients underwent follow-up with endometrial sampling by hysteroscopy and curettage for endometrial response every 3 months.ResultsAfter a median follow-up of 18.7 months (range, 5.6–54.9 months), 15 women (88.2%) in the EC group and 12 women (100%) in the CAH group had complete response (CR) after GnRHa combination treatment. Among the women who achieved CR, 1 woman (8.3%) with CAH and 1 woman (5.9%) with EC had recurrence after CR, and they finally underwent a hysterectomy. Time to CR was similar in the 2 groups (4.5 ± 1.9 months in the CAH group vs 5.0 ± 2.9 months in the EC group). Ten women (34.5%) had CR after the first 3 months, 8 women (27.6%) had CR after 6 months, and 9 women (31.0%) had CR after 9 months.ConclusionsBoth GnRHa with the levonorgestrel-releasing intrauterine system and GnRHa with letrozole are alternative treatments for women with CAH and EC who desire fertility preservation. A larger multicenter trial of the fertility-preserving treatment is warranted.

scholarly journals Management of Recurrent Endometrial Cancer or Atypical Endometrial Hyperplasia Patients After Primary Fertility-Sparing Therapy

2021 ◽  
Vol 11 ◽  
Author(s):  
Junyu Chen ◽  
Dongyan Cao ◽  
Jiaxin Yang ◽  
Mei Yu ◽  
Huimei Zhou ◽  
...  
Keyword(s):  
Endometrial Cancer ◽  
Endometrial Hyperplasia ◽  
Recurrence Time ◽  
The Third ◽  
Atypical Endometrial Hyperplasia ◽  
Fertility Sparing ◽  
Recurrent Endometrial Cancer ◽  
Desire To Conceive ◽  
To Receive

ObjectiveTo evaluate the efficacy and prognosis of fertility-sparing re-treatment on patients with recurrent endometrial cancer (EC) and atypical endometrial hyperplasia (AEH) who wish to preserve their uterus after complete remission (CR) for primary conservative therapy.MethodsWe performed a retrospective study on recurrent EC or AEH patients who received fertility-sparing re-treatment after achieving CR. Data regarding clinicopathological factors, adverse events, treatment efficacy, tumor prognosis, and reproductive outcome were analyzed.ResultsOf the 98 recurrent patients with a median disease-free interval period of 19 (3–96) months, 18 patients decided to receive hysterectomy directly, and 80 patients received fertility-preserving re-treatment. Seventy-one (88.6%) cases achieved CR, 96.0% in AEH and 75.8% in EC patients, with the 6 (3–16) months’ median CR time. Seven (8.8%) patients failed to achieve CR and then underwent the hysterectomy: one partial response (PR), four stable disease (SD), and two progressive disease (PD). Forty-nine women attempted to get pregnant after CR, 13 (26.5%) became pregnant, seven (14.3%) successfully delivered, and six (12.2%) miscarried. During the follow-up period, 22 (31.0%) women had developed a second relapse with the median recurrence time of 12 (4–90) months, and 10 patients decided to receive the third round of fertility-sparing treatment. Seven (70.0%) patients, 33.3% in EC and 85.7% in AEH, achieved CR again. Hysterectomy was performed in two (20.0%) patients due to SD. After the third-round treatment, six women had the desire to conceive but no one became pregnant successfully.ConclusionFor patients with recurrent EC and AEH after primary conservative treatment, fertility-preserving re-treatment can still achieve a promising response, and patients have possibilities of completing childbirth.

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