Progestin-releasing intrauterine device insertion plus palliative radiotherapy in frail, elderly uterine cancer patients unfit for radical treatment

Abstract

The present study investigated the combination of levonorgestrel-releasing intrauterine device (LNG-IUD) insertion and palliative radiotherapy (RT) as a potential approach for treating frail, elderly endometrial cancer (EC) patients considered unfit for curative oncological treatments. The inclusion criteria were an age of ≥65 years, pathological confirmation of a uterine neoplasm, a Charlson comorbidity index (CCI) value of ≥4 and the presence of vaginal bleeding. Patients underwent intrauterine insertion of an LNG-IUD, and thereafter, received a total dose of 30 Gy at 3 Gy per fraction, over 10 days. The clinical target volume (CTV) was defined as the uterus and disease-involved tissues in the pelvis plus a 1-cm margin. The planning target volume was obtained by adding a 1-cm isotropic margin to the CTV. A total of 9 patients with EC (median age, 85 years; Eastern Cooperative Oncology Group performance status ≥2, ≥88.8%; obesity, 55.5%; median CCI, 5) received an LNG-IUD plus RT. An early complete resolution of bleeding was documented in 8 patients (88.8%), while the remaining patient experienced a marked improvement. The median duration of bleeding control was 18 months, while the 2-year actuarial rate of bleeding-free survival was 53.3% (median follow-up time, 20 months; range, 9-60 months). No LNG-IUD- or severe RT-related complications were documented. Overall, a high rate of bleeding remission, durable bleeding-free survival in face of the easy intrauterine insertion of an LNG-IUD and a negligible toxicity profile of the complete treatment were documented in this study, indicating a requirement for further investigation in a larger series.

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

“…Progestin treatment of patients with atypical hyperplasia has been studied previously, with recent meta-analyses showing disease remission in 66-85.6% patients, and LNG-IUS once again showed better therapeutic results [7,16]. Recent prospective studies have been conducted regarding the treatment of patients with endometrial cancer stage 1a, who were unfit for surgery, with LNG-IUS and concurrent radiotherapy [17] or only LNG-IUS [18]. The former study showed good remission rate with an overall 2-year survival greater than 75% and well-controlled bleeding in all the cases.…”

Optimizing Palliative Pelvic Radiotherapy in Gynecological Cancers: A Systematic Review and Analysis

“…Palliative radiotherapy exhibits substantial promise in controlling symptoms associated with gynecological cancers. As summarized in Table 2 , studies demonstrate varying success rates in alleviating symptoms like bleeding, pain, and vaginal discharge across different treatment regimens [ 14 , 15 , 18 , 20 , 22 , 23 , 24 , 25 , 27 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ].…”

The role of endometrial sampling for surveillance of recurrence in postmenopausal patients with medically inoperable stage I endometrial cancer

“…Though treatment of EC by progestin therapy is largely based on studies of younger women desiring future fertility, our study, along with others, suggests there may also be a role for progestin therapy to treat postmenopausal women if RT is not feasible or desired ( Baker et al, 2012 , Staples et al, 2018 ). Macchia and colleagues reported on 9 women aged ≥65 years treated with LNG-IUD followed by palliative radiation (30 Gy) and showed a high bleeding remission rate of 88.8% ( Macchia et al, 2016 ). Median follow-up was 20 months, but they did not report recurrence or survival data.…”