Yıl: 2021 Cilt: 51 Sayı: 4 Sayfa Aralığı: 2066 - 2072 Metin Dili: İngilizce DOI: 10.3906/sag-2012-207 İndeks Tarihi: 14-01-2022

Outcomes of the conservative management of the patients with endometrial intraepithelial neoplasia/endometrial cancer: Wait or treat!

Öz:
Background/aim: The objective of the study was to evaluate the response, relapse, reproductive results and demographic features of the patients with endometrioid adenocancer (EAC) and endometrial intraepithelial neoplasia (EIN) who were treated with conservative treatment. This is the largest study when we consider the single center studies in this field. Materials and methods: In the current retrospective study, 38 patients (6 EAC, 31 EIN, 1 synchronous tumors of ovary and endometrium) were recruited. They were treated with progesterone products for their fertility desire and comorbidity. Reproductive results, response rates, and recurrence rates were calculated and survival analyses were performed. Results: Mean duration of the medical treatment was 10 months (range 2–60). Among the 32 patients with EIN, 28 (87.5%) had a response, 8 (25%) had a relapse and 4 (12.5%) had persistence. Among the 32 patients who expecting fertility, seven patients got pregnant (21.8%) with a total of five live births. The median follow-up was 40.5 months (range 3–180), and recurrence-free interval was 28.7 months (range 2–180). Conclusion: Fertility-sparing treatment of EAC and EIN is a feasible approach, and the eligible patients should be given a chance to get pregnant.Key words: Fertility-sparing treatment, endometrial cancer, endometrial intraepithelial neoplasia, reproductive outcome, survival
Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
  • 1. Wang Y, Yu M, Yang J, Cao D, Yuan Z et al. Prolonged conservative treatment in patients with recurrent endometrial cancer after primary fertility-sparing therapy: 15-year experience. International Journal of Clinical Oncology 2019; 24 (6): 712-720. doi: 10.1007/s10147-019-01404-2
  • 2. Jemal A, Bray F, Center MM, Ferlay J, Ward E et al. Global cancer statistics. CA: A Cancer Journal for Clinicians 2011; 61 (2): 69-90. doi: 10.3322/caac.20107
  • 3. Chen W, Zheng R, Baade PD, Zhang S, Zeng H et al. Cancer statistics in China, 2015. CA: A Cancer Journal for Clinicians 2016; 66 (2): 115-132. doi: 10.3322/caac.21338
  • 4. Corzo C, Barrientos Santillan N, Westin SN, Ramirez PT. Updates on conservative management of endometrial cancer. The Journal of Minimally Invasive Gynecology. 2018; 25 (2): 308-313. doi: 10.1016/j.jmig.2017.07.022
  • 5. Berek JS and Hacker NF. Berek and Hacker’s Gynecologic Oncology. 6th ed. Philadelphia, USA: ……. ; 2015:390-442.
  • 6. Travaglino A, Raffone A, Saccone G, Insabato L, Mollo A et al. Immunohistochemical predictive markers of response to conservative treatment of endometrial hyperplasia and early endometrial cancer: a systematic review. Acta Obstetricia et Gynecologica Scandinavica 2019; 98 (9): 1086-1099. doi: 10.1111/aogs.13587
  • 7. Gallos ID, Alazzam M, Clark TJ, Faraj R, Rosenthal AN et al. Management of Endometrial Hyperplasia Green-top Guideline No. 67 RCOG/BSGE Joint Guideline | February 2016.
  • 8. Chandra V, Kim JJ, Benbrook DM, Dwivedi A, Rai R. Therapeutic options for management of endometrial hyperplasia. Journal of Gynecologic Oncology 2016; 27 (1): e8. doi: 10.3802/jgo.2016.27.e8
  • 9. Park JY, Lee SH, Seong SJ, Kim DY, Kim TJ et al. Progestin re-treatment in patients with recurrent endometrial adenocarcinoma after successful fertility-sparing management using progestin. Gynecologic Oncology 2013; 129 (1): 7-11. doi: 10.1016/j.ygyno.2012.12.037
  • 10. Yamagami W, Susumu N, Makabe T, Sakai K, Nomura H et al. Is repeated highdose medroxyprogesterone acetate (MPA) therapy permissible for patients with early stage endometrial cancer or atypical endometrial hyperplasia who desire preserving fertility? Journal of Gynecologic Oncology 2018; 29 (2): e21. doi: 10.3802/jgo.2018.29.e21
  • 11. Zhang Q, Qi G, Kanis M.J, Dong R, Cui B et al. Comparison among fertility-sparing therapies for well differentiated early-stage endometrial carcinoma and complex atypical hyperplasia. Oncotarget 2017; 8 (34): 57642-57653. doi: 10.18632/oncotarget.17588
  • 12. Orbo A, Vereide AB, Arnes M, Pettersen I, Straume B. Levonorgestrel-impregnated intrauterine device as treatment for endometrial hyperplasia:a national multicentre randomised trial. British Journal of Obstetrics and Gynaecology 2014; 121 (4): 477-486. doi: 10.1111/1471-0528.12499
  • 13. Gallos ID, Shehmar M, Thangarantinam S, Papapostolou TK, Coomarasamy A et al. Oral progestogens vs levonorgestrelreleasing intrauterine system for endometrial hyperplasia: a sysytematic review and metaanalysis. American Journal of Obstetrics and Gynecology 2010; 203 (6): 547.e1-e10. doi: 10.1016/j.ajog.2010.07.037
  • 14. Fan Z, Li H, Hu R, Liu Y, Liu X et al. Fertility-preserving treatment in young women with grade 1 presumed stage IA endometrial adenocarcinoma: A meta-analysis. International Journal of Gynecological Cancer 2018; 28 (2): 385-393 .doi: 10.1097/IGC.0000000000001164
  • 15. Qin Y, Yu Z, Yang J, Cao D, Yu M et al. Oral progestin treatment for early-stage endometrial cancer: a systematic review and metaanalysis. International Journal of Gynecological Cancer 2016; 26 (6): 1081-1091. doi: 10.1097/IGC.0000000000000723
  • 16. Kim MK, Yoon BS, Park H, Seong SJ, Chung HH et al. Conservative treatment with medroxyprogesterone acetate plus levonorgestrel intrauterine system for early-stage endometrial cancer in young women: pilot study. International Journal of Gynecological Cancer 2011; 21 (4): 673-677. doi: 10.1111/ IGC.0b013e318fd9a06
  • 17. Rodolakis A, Biliatis I, Morice P, Reed N, Mangler M et al. European society of gynecological oncology task force for fertility preservation: clinical recommendations for fertilitysparing management in young endometrial cancer patients. International Journal of Gynecological Cancer 2015; 25 (7): 1258-1265. doi: 10.1097/IGC.0000000000000493
  • 18. Koskas M, Uzan J, Luton D, Rouzier R, Darai E et al. Prognostic factors of oncologic and reproductive outcomes in fertilitysparing management of endometrial atypical hyperplasia and adenocarcinoma: systematic review and meta-analysis. Fertility and Sterility 2014; 101 (3): 785-794. doi: 10.1016/j. fertnstert.2013.11.028
  • 19. Gonthier C, Walker F, Luton D, Yazbeck C, Madelenat P et al. Impact of obesity on the results of fertility-sparing management for atypical hyperplasia and grade 1 endometrial cancer. Gynecologic Oncology. 2014; 133 (1): 33-37. doi:10.1016/j. ygyno.2013.11.007
  • 20. Signorelli M, Caspani G, Bonazzi C, Chiappa V, Perego P et al. Fertility-sparing treatment in young women with endometrial cancer or atypical complex hyperplasia: a prospective singleinstitution experience of 21 cases. British Journal of Obstetrics and Gynaecology 2009; 116 (1): 114-118. doi:10.1111/j.1471- 0528.2008.02024.x
  • 21. Yamazawa K, Hirai M, Fujito A, Nishi H, Terauchi F et al. Fertility-preserving treatment with progestin, and pathological criteria to predict responses, in young women with endometrial cancer. Human Reproduction 2007; 22 (7): 1953-1958. doi:10.1093/humrep/dem088
  • 22. Hurst SA, Hartzfeld KM and Del Priore G. Occult myometrial recurrence after progesterone therapy to preserve fertility in a young patient with endometrial cancer. Fertility and Sterility 2008; 89 (3): 724.e721-e724. doi:10.1016/j. fertnstert.2007.03.068
APA Isci Bostanci E, Durmuş Y, Duru Çöteli S, KAYIKCIOGLU F, Boran N (2021). Outcomes of the conservative management of the patients with endometrial intraepithelial neoplasia/endometrial cancer: Wait or treat!. , 2066 - 2072. 10.3906/sag-2012-207
Chicago Isci Bostanci Esra,Durmuş Yasin,Duru Çöteli Sinem Ayşe,KAYIKCIOGLU FULYA,Boran Nurettin Outcomes of the conservative management of the patients with endometrial intraepithelial neoplasia/endometrial cancer: Wait or treat!. (2021): 2066 - 2072. 10.3906/sag-2012-207
MLA Isci Bostanci Esra,Durmuş Yasin,Duru Çöteli Sinem Ayşe,KAYIKCIOGLU FULYA,Boran Nurettin Outcomes of the conservative management of the patients with endometrial intraepithelial neoplasia/endometrial cancer: Wait or treat!. , 2021, ss.2066 - 2072. 10.3906/sag-2012-207
AMA Isci Bostanci E,Durmuş Y,Duru Çöteli S,KAYIKCIOGLU F,Boran N Outcomes of the conservative management of the patients with endometrial intraepithelial neoplasia/endometrial cancer: Wait or treat!. . 2021; 2066 - 2072. 10.3906/sag-2012-207
Vancouver Isci Bostanci E,Durmuş Y,Duru Çöteli S,KAYIKCIOGLU F,Boran N Outcomes of the conservative management of the patients with endometrial intraepithelial neoplasia/endometrial cancer: Wait or treat!. . 2021; 2066 - 2072. 10.3906/sag-2012-207
IEEE Isci Bostanci E,Durmuş Y,Duru Çöteli S,KAYIKCIOGLU F,Boran N "Outcomes of the conservative management of the patients with endometrial intraepithelial neoplasia/endometrial cancer: Wait or treat!." , ss.2066 - 2072, 2021. 10.3906/sag-2012-207
ISNAD Isci Bostanci, Esra vd. "Outcomes of the conservative management of the patients with endometrial intraepithelial neoplasia/endometrial cancer: Wait or treat!". (2021), 2066-2072. https://doi.org/10.3906/sag-2012-207
APA Isci Bostanci E, Durmuş Y, Duru Çöteli S, KAYIKCIOGLU F, Boran N (2021). Outcomes of the conservative management of the patients with endometrial intraepithelial neoplasia/endometrial cancer: Wait or treat!. Turkish Journal of Medical Sciences, 51(4), 2066 - 2072. 10.3906/sag-2012-207
Chicago Isci Bostanci Esra,Durmuş Yasin,Duru Çöteli Sinem Ayşe,KAYIKCIOGLU FULYA,Boran Nurettin Outcomes of the conservative management of the patients with endometrial intraepithelial neoplasia/endometrial cancer: Wait or treat!. Turkish Journal of Medical Sciences 51, no.4 (2021): 2066 - 2072. 10.3906/sag-2012-207
MLA Isci Bostanci Esra,Durmuş Yasin,Duru Çöteli Sinem Ayşe,KAYIKCIOGLU FULYA,Boran Nurettin Outcomes of the conservative management of the patients with endometrial intraepithelial neoplasia/endometrial cancer: Wait or treat!. Turkish Journal of Medical Sciences, vol.51, no.4, 2021, ss.2066 - 2072. 10.3906/sag-2012-207
AMA Isci Bostanci E,Durmuş Y,Duru Çöteli S,KAYIKCIOGLU F,Boran N Outcomes of the conservative management of the patients with endometrial intraepithelial neoplasia/endometrial cancer: Wait or treat!. Turkish Journal of Medical Sciences. 2021; 51(4): 2066 - 2072. 10.3906/sag-2012-207
Vancouver Isci Bostanci E,Durmuş Y,Duru Çöteli S,KAYIKCIOGLU F,Boran N Outcomes of the conservative management of the patients with endometrial intraepithelial neoplasia/endometrial cancer: Wait or treat!. Turkish Journal of Medical Sciences. 2021; 51(4): 2066 - 2072. 10.3906/sag-2012-207
IEEE Isci Bostanci E,Durmuş Y,Duru Çöteli S,KAYIKCIOGLU F,Boran N "Outcomes of the conservative management of the patients with endometrial intraepithelial neoplasia/endometrial cancer: Wait or treat!." Turkish Journal of Medical Sciences, 51, ss.2066 - 2072, 2021. 10.3906/sag-2012-207
ISNAD Isci Bostanci, Esra vd. "Outcomes of the conservative management of the patients with endometrial intraepithelial neoplasia/endometrial cancer: Wait or treat!". Turkish Journal of Medical Sciences 51/4 (2021), 2066-2072. https://doi.org/10.3906/sag-2012-207