scholarly journals Comparison among fertility-sparing therapies for well differentiated early-stage endometrial carcinoma and complex atypical hyperplasia

Oncotarget ◽  
2017 ◽  
Vol 8 (34) ◽  
pp. 57642-57653 ◽  
Author(s):  
Qing Zhang ◽  
Gonghua Qi ◽  
Margaux J. Kanis ◽  
Ruifen Dong ◽  
Baoxia Cui ◽  
...  
Keyword(s):  
Endometrial Carcinoma ◽  
Early Stage ◽  
Atypical Hyperplasia ◽  
Fertility Sparing ◽  
Well Differentiated

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.

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.

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