GnRH Analogues, Transvaginal Ultrasound-Guided Drainage and Intracystic Injection of Recombinant Interleukin-2 in the Treatment of Endometriosis

Abstract

We performed a double-blind, randomised controlled trial to evaluate the results of ultrasound-guided aspiration of endometriomas under the effect of GnRH analogues and a possible additional beneficial effect by leaving 600,000 IU of recombinant interleukin-2 (rIL-2) in the cysts. Twenty-four women with endometriosis-related symptoms, increased values of CA-125 and transvaginal ultrasonography showing endometriomas >3 cm who were initially sent to us for laparotomy and conservative surgery for endometriosis were included. Main outcome measures were severity of symptoms, size and percentage of echographical reduction of endometriomas and CA-125 levels after 2 menses post-GnRH analogues. Secondary outcome measures were the time until recurrence of abnormal parameters and the need for surgery after treatment. We found moderate clinical results after treatment with drainage plus GnRH analogues and significantly improved results in women having received rIL-2 intracystically. There were no side effects. Two out of 3 previously infertile patients became pregnant after therapy. Though the rates of recurrence of endometriomas ≧3 cm were similar in both groups, the period until recurrence was significantly greater when rIL-2 was used, and the rates of recurrence of symptoms and increased CA-125 values were also significantly lower in patients who received rIL-2. Surgery was finally performed on 10 patients (4 with and 6 without previous rIL-2 treatment) during follow-up (30 ± 12.7 months). These findings led to the conclusion that transvaginal ultrasound-guided puncture and aspiration of endometriomas under endometrial suppressive therapy with GnRH analogues have some value for endometriosis treatment, improving the clinical manifestations and avoiding some surgical therapies, and that rIL-2 left in the cyst increases these beneficial effects significantly.

Aspiration and ethanol sclerotherapy to treat recurrent ovarian endometriomas prior to in vitro fertilization – a pilot study

“…Aspiration is a less invasive, quicker, and less expensive procedure than surgery (17) , but it has a greater rate of recurrence and has restrictions on its broader application. Currently, the use of sclerosing substances has been proposed following aspiration with substances including tetracycline (9) , methotrexate (10) , interleukin 2 (18) , and ethanol (11) . Sclerotherapy was originally used to treat tuberculosis and is currently used by oncologists to treat pleural effusions caused by cancer.…”

Mast cells in endometriosis: guilty or innocent bystanders?

“…For example, it has been claimed that, in affected women, refluxed endometrial cells are able to escape T-cell-driven immune surveillance [2] and that T-cell activating drugs should ameliorate the disease. However, in two small randomized clinical trials, the immune-stimulatory cytokines IL-2 and IFN-a had no effect on lesion size or pain [3,4]. These results indicate that these two cytokines cannot repair defects in immune surveillance or that impaired T-cell function is not critical to EMS pathogenesis.…”

Endometrioma and ART: Does the Needle Work?

“…An alternative to surgery in some cases might be ultrasound-guided aspiration of ovarian endometriomas, a procedure first proposed by Aboulghar et al 9 Whether it is just cyst aspiration or aspiration plus in situ irrigation or injection with a sclerosing agent in order to reduce recurrence, has no convincing published evidence. Sclerosing substances used vary from tetracycline 10 to methotrexate, 11 recombinant interleukin-2, 12 and/or ethanol. 13 For those patients who decline surgery, or in whom surgery is contraindicated, cyst aspiration may suggesting that this risk is at least below 1.7%.…”