Medically unfit women with early-stage endometrial cancer treated with the levonorgestrel intrauterine system

ObjectiveTo assess the clinical efficacy of the levonorgestrel intrauterine system (LNG-IUS) in the treatment of early-stageendometrial cancer in elderly morbidly obese women, whose multiple co-morbidities made the standard surgicaltreatment too risky to undertake.MethodsA retrospective review was conducted and case series reports were prepared of all women diagnosed withendometrial cancer, from April 2011 to December 2016 at the Queen's Hospital, London, to identify women unfit forsurgery and treated with the LNG-IUS.ResultsOut of 438 women with endometrial cancer, Eight women with early-stage endometrial cancer were deemed unfitfor surgery and underwent treatment with the LNG-IUS. All had grade 1 endometrioid endometrial adenocarcinoma,radiologically staged as 1a. Four women died of their co-morbidities, not related to endometrial cancer. One of themhad 68 months of progression-free survival before death due to co-morbidities. One patient required a hysterectomyafter 32 months of treatment with LNG-IUS and oral progestogens due to heavy vaginal bleeding. Three women havecontinued the LNG-IUS treatment with no evidence of progressive disease symptoms till date at a mean follow-up of35.7 months.ConclusionFor women with multiple co-morbidities, the LNG-IUS offers an effective and safe treatment for early-stage, lowgradeendometrial cancer, with no cases of symptomatic progression reported in our case series. In the frail andelderly, where the quality of life is of paramount importance, surgical treatment may not offer additional long-termsurvival benefits.