NEW YORK (Reuters Health) – Conservative treatment of low-risk endometrial cancer and complex atypical hyperplasia with the levonorgestrel-releasing intrauterine device (LNG-IUD) appears effective in most patients, according to a retrospective case series.
Surgery is the standard of care for both conditions, but this treatment may not be best for women with comorbid conditions precluding surgery or those who still want to have children, say Dr. Navdeep Pal and colleagues from University of Texas MD Anderson Cancer Center in Houston.
As reported in Obstetrics and Gynecology online December 4, they took a look back at 46 women diagnosed with complex atypical hyperplasia or early-grade endometrial cancer and treated with the LNG-IUD for a median of 24 months.
Thirty-two of the 46 patients had biopsy results at six months. Of these, 15 had complex atypical hyperplasia (47%), nine had grade 1 endometrial cancer (28%), and eight had grade 2 endometrial cancer (25%).
The overall response rate at six months was 75% (24 of 32 women). It was 80% in women with complex atypical hyperplasia, 67% in those with grade 1 endometrial cancer, and 75% in those with grade 2 endometrial cancer.
There were 16 (50%) complete responses, defined as either no evidence of hyperplasia or hyperplasia without atypia on pathology report, and 8 (25%) partial responses.
These “higher than expected response rates,” say the researchers, “may be related to careful selection of patients for conservative therapy or the result of bias inherent to retrospective studies.”
Nonresponders had a larger uterine size based on maximum uterine diameter (9.3 vs. 8 cm) but there was no difference in response based on BMI, age, parity or race.
The researchers note that prior progesterone therapy did not appear to affect the response to LNG-IUD therapy. “The transition of patients previously treated with oral progesterone to the LNG-IUD may be an option when patients are unwilling or unable to undergo definitive surgical therapy. This finding has not been reported in the literature and will be studied further in our ongoing prospective trial of the LNG-IUD for primary treatment of patients with early endometrial neoplasia,” they write.
Summing up, Dr. Pal and colleagues say, “Optimal management of patients with complex atypical hyperplasia or endometrial cancer who desire future fertility is unknown. At our center, we treat patients with progesterone until an endometrial biopsy is negative for 1 year. The IUD is removed when the patient is ready to attempt pregnancy. At completion of childbearing, the patient is followed like any patient in surveillance for endometrial cancer, focusing on symptoms that may indicate recurrence. The decision for performance of postchildbearing hysterectomy is left to discussion between the physician and the patient.”
The study had no commercial funding. One author reported financial ties to Clovis Oncology.
SOURCE: http://bit.ly/2AQz5Sy
Obstet Gynecol 2017.
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