Combined Oral Medroxyprogesterone/Levonorgestrel-Intrauterine System Treatment for Women With Grade 2 Stage IA Endometrial Cancer

Hwang, Ji Young; Kim, Da Hee; Bae, Hyo Sook; Kim, Miseon; Jung, Yong Wook; Yun, Bo Hyon; Seong, Seok Ju; Shin, Eunah; Kim, Mi Kyoung

doi:10.1097/igc.0000000000000927

Cited by 49 publications

(59 citation statements)

References 19 publications

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“…The overall complete remission rate was 87.5% (14/16), and the average time to complete remission was 9.8±8.9 months (range 3–35 months) 28. Hwang et al studied five patients with endometrioid endometrial cancer treated with combined oral medroxyprogesterone acetate and levonorgestrel-release intra-uterine devices, with a complete response in three out of five patients 42. Thus, concurrent treatment might have a better response rate than single agent management.…”

Section: Discussionmentioning

confidence: 99%

Pregnancy and oncologic outcomes after fertility-sparing management for early stage endometrioid endometrial cancer

Chae

Shim

Lee

et al. 2019

Int J Gynecol Cancer

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ObjectiveHormonal management is an alternative treatment for preserving fertility in patients with presumed early stage endometrioid endometrial cancer. This study aimed to define the pregnancy and oncologic outcomes and factors of successful conception after hormone therapy for endometrioid endometrial cancer.MethodsWe retrospectively analyzed patients presumed to have stage IA, grade 1–2 endometrioid endometrial cancer who underwent fertility-sparing treatment. Concurrent medroxyprogesterone and levonorgestrel-release intra-uterine devices were used for treatment. The pregnancy outcomes and oncologic outcomes were compared between the pregnant and non-pregnant groups.ResultsSeventy-one patients presumed to have stage IA, grade 1–2 endometrioid endometrial cancer had complete remission, and 49 of them tried to conceive. Twenty-two (44.9%) patients became pregnant; the total number of pregnancies was 30. These pregnancies resulted in seven abortions (23.3%), one pre-term birth (3.3%), and 20 full-term births (66.6%). The total live birth rate was 66.6 % (20/30). The median duration of hormonal treatment was 11.9 months (range 4–49) and 12.0 months (range 3–35) in the pregnant and non-pregnant groups, respectively. On multivariate analysis, age, body mass index, treatment duration, medroxyprogesterone dose, and number of dilatation and curettage biopsies were not significantly associated with pregnancy failure, but the association with grade (OR 6.2, 95% CI 1.0 to 38.9; P<0.05) was statistically significant. The median disease-free survival duration was 26 months (range 20–38) and 12 months (range 4–48) in the pregnant and non-pregnant groups, respectively (P<0.05, log-rank test).ConclusionsA lower grade might be a positive factor for future pregnancy. Moreover, successful pregnancy might be a factor in preventing recurrence.

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Section: Discussionmentioning

confidence: 99%

Pregnancy and oncologic outcomes after fertility-sparing management for early stage endometrioid endometrial cancer

Chae

Shim

Lee

et al. 2019

Int J Gynecol Cancer

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“…Recent studies have shown that the incidence of EC is rising yearly ( 1 ). According to statistical data, the morbidity of EC ranks second among female reproductive tract tumors, second only to cervical cancer ( 2 ). It has been found that EZH2 is a core component of the family of Polycomb group proteins ( 3 ).…”

Section: Introductionmentioning

confidence: 99%

Expression of EZH2 in endometrial carcinoma and its effects on proliferation and invasion of endometrial carcinoma cells

Zhang

Huai

2017

Oncol Lett

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Expression of enhancer of zeste homolog 2 (EZH2) has been implicated in cancer pathology, but research on its mechanistic activity is limited. The present study sought to assess the levels expression of EZH2 in patients with endometrial carcinoma (EC) and to explore the effects of EZH2 downregulation on the biological behavior of endometrial carcinoma RL-952 cells. Samples were obtained from a total of 104 patients with EC and an immunohistochemical assay was used to detect the expression of EZH2 in cancer and adjacent tissues. The relationship between the expression of EZH2 and the clinicopathological features was analyzed. Endometrial carcinoma RL-952 cells were transfected with chemically synthesized siRNA to conduct targeting inhibition of EZH2 expression. The expression levels of EZH2 protein were detected by immunoblotting. MTT and Transwell assays were used to detect the changes of cell proliferation and invasion after EZH2 downregulation. Of the 104 cases of endometrial carcinoma samples, 71 cases showed positive expression of EZH2, with an expression rate of 68.27%. In 104 cases of adjacent tissue samples, 25 cases showed positive expression of EZH2, with an expression rate of 24.03%. The expression of EZH2 in endometrial carcinoma tissue was significantly higher than that in adjacent tissue (P<0.05). The expression of EZH2 in endometrial carcinoma tissue was not correlated with the menopausal status and age of patients (P>0.05), but was correlated with the histological grade, depth of tumor invasion, lymph node metastasis and TNM stage (P<0.05). The expression of E2H2 was significantly downregulated by si-E2H2 and the proliferation and invasion abilities of cells were significantly reduced after EZH2 downregulation (P<0.05). EZH2 is closely related to the development of endometrial carcinoma and can enhance the proliferative activity of endometrial carcinoma RL-952 cells and promote cell invasion.

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“…Conservative treatment of endometrial adenocarcinoma traditionally involved oral progestin therapy; more recently, many reports have introduced LNG-IUS alone or combined with GnRHa or oral progestin as an alternative to oral systemic progestin alone for the treatment of women with EC and AH (24,(27)(28)(29)(30). Brown et al (24) in 2012 reported a case of an 18-yearold girl with grade 2 endometrioid adenocarcinoma, treated with LNG-IUS successfully.…”

Section: Discussionmentioning

confidence: 99%

“…Brown et al (24) in 2012 reported a case of an 18-yearold girl with grade 2 endometrioid adenocarcinoma, treated with LNG-IUS successfully. Hwang et al (27) evaluated the efficacy of combined MPA/LNG-IUS treatment for grade 2 stage IA EC; the CR rate was 60% (3/5), and one patient (13.3%) who relapsed after 14 months achieving CR received combined therapy and achieved CR by 6 months again. A prospective observational study showed that for grade 1 EC, combined oral MPA/LNG-IUS treatment was more effective than oral progestin alone (31).…”

Section: Discussionmentioning

confidence: 99%

Fertility-Sparing Treatment in Young Patients With Grade 2 Presumed Stage IA Endometrioid Endometrial Adenocarcinoma

Wang

Yuan

et al. 2020

Front. Oncol.

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Purpose: To investigate the efficacy of fertility-sparing treatment for young women with grade 2 presumed stage IA endometrioid endometrial adenocarcinoma (EEA). Methods: We performed a retrospectively review of eight patients affected by grade 2 presumed stage IA endometrioid endometrial adenocarcinoma who underwent fertility-sparing treatment in the Peking Union Medical College Hospital between 2011 and 2018. Results: The median age of patients was 26 years (range, 22-35 years). Complete response (CR) was found in seven of the eight cases. The median time to response was 3 months (range, 3-9 months). Among patients who achieved CR, three had recurrence and were treated with second-line fertility-sparing therapy. Two of the three recurrent patients achieved CR, and one patient subsequently conceived. Pregnancies and successful deliveries were achieved in two of four patients. The average follow-up period was 31 months (range, 21-77 months). Conclusions: Fertility-sparing therapy is a feasible treatment option in patients with presumed stage IA, grade 2 endometrial cancer. Although our results are encouraging, they are based on very limited numbers, and patients should be informed the risk of tumor progression during treatment. Further evaluations are still required before recommending fertility-sparing therapy to endometrial cancer patients with more advanced disease in routine practice.

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Combined Oral Medroxyprogesterone/Levonorgestrel-Intrauterine System Treatment for Women With Grade 2 Stage IA Endometrial Cancer

Cited by 49 publications

References 19 publications

Pregnancy and oncologic outcomes after fertility-sparing management for early stage endometrioid endometrial cancer

Pregnancy and oncologic outcomes after fertility-sparing management for early stage endometrioid endometrial cancer

Expression of EZH2 in endometrial carcinoma and its effects on proliferation and invasion of endometrial carcinoma cells

Fertility-Sparing Treatment in Young Patients With Grade 2 Presumed Stage IA Endometrioid Endometrial Adenocarcinoma

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