Levonorgestrel‐releasing intrauterine system (Mirena^®) as a therapy for endometrial hyperplasia and carcinoma

Controversies of the Hormonal Conservative Treatment of Endometrial Cancer

“…The 2 cases with stable disease underwent radical surgery showing G1-EC limited to the inner half of the myometrium (FIGO stage IB). Bahamondes et al [43] presented 2 cases of G1-EC limited to the endometrium in severely obese women with high surgical risk treated with LNG-IUD plus gastroplasty. Hysterectomy was performed 7 months later showing G1-EC limited to the endometrium in 1 patient and to the inner half of the myometrium in another case.…”

Challenging Regimen for Long-Term Conservative Treatment of Endometrial Adenocarcinoma in Young Women: A Case Report and Review of the Literature

“…A novel progestin-medicated IUD, LNG-IUS, was shown to be effective for the prevention of endometrial hyperplasia in postmenopausal hormone therapy [20,21,22] and for the treatment of endometrial hyperplasia with or without atypia [23,24,25]. At present, 7 cases of endometrial carcinoma treated with LNG-IUS have been reported as summarized in table 1 ; 2 cases had complete response 5-6 months after insertion of the IUS, whereas 4 cases with persistent cancer had hysterectomy and the specimens showed myometrial invasion [11,12,13]. It is likely that the non-response to progestin therapy, either to local [11, 12] or oral [6] regimens, might be due to the pre-existing myometrial invasion.…”

“…At present, 7 cases of endometrial carcinoma treated with LNG-IUS have been reported as summarized in table 1 ; 2 cases had complete response 5-6 months after insertion of the IUS, whereas 4 cases with persistent cancer had hysterectomy and the specimens showed myometrial invasion [11,12,13]. It is likely that the non-response to progestin therapy, either to local [11, 12] or oral [6] regimens, might be due to the pre-existing myometrial invasion. There is evidence that transvaginal ultrasonography and MRI may be promising tools for the evaluation of myometrial invasion [26, 27], therefore these tools would be valuable in case selection for conservative treatment.…”

“…Alternatively, conservative treatment with high-dose progestin is feasible in young women who wish to retain their reproductive function [3, 6,7,8,9], as cancers in these women are usually well-differentiated and in an early stage at the time of diagnosis [1, 10]. Unfortunately, some reports showed that obese patients may not optimally respond to either systemic or local progestin therapy [11, 12], but a combination of both therapies may intensify the therapeutic effect [13]. In this report, we present a case of clinical stage I well-differentiated endometrial carcinoma in an obese, young Thai woman with polycystic ovary syndrome (PCOS) treated with a combination of levonorgestrel intrauterine system (LNG-IUS) and an oral progestin, megestrol acetate (MA).…”

Successful Treatment of Early Endometrial Carcinoma by Local Delivery of Levonorgestrel: A Case Report

“…There are only a few reports in the literature which demonstrate successful treatment of early stage endometrial carcinoma with the LNG-releasing intrauterine system (IUS) [2–5]. We present a case of a 67-year-old woman with a moderately differentiated invasive adenocarcinoma of the endometrium who was successfully treated with the LNG-IUS.…”