Uterine Sparing Treatment in Women with Endometrioid Adenocarcinoma using a Combination of GnRH-a, an Aromatase Inhibitor and a Progestin: Report of 5 Cases and Review of the Literature.
CANSAGE ePoster Library. Vilos A. 09/26/19; 275260; eP-127
Angelos Vilos
Angelos Vilos
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Abstract
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Background: Endometrioid adenocarcinoma in reproductive aged women is associated with infertility, increased age, obesity (2-5 times) due to excessive estrogen and anovulatory menstruation due to lack of progesterone and unopposed estrogen. Consequently, with increasing prevalence of obesity and delaying first childbirth, physicians encounter increased numbers of women with endometrial cancer seeking fertility enhancement or requiring preservation of fertility and/or their uterus. Objectives: We hypothesized that total elimination of estrogen production and providing progestogenic effects would effectively spare the uterus in women with endometrioid adenocarcinoma requiring enhancement or preservation of fertility.Methods: Five women, aged 34-44 years, BMI 35-64kg/m2, presented with infertility (n=3), AUB (n=5), fibroids (n=3), PCOs (n=3). Endometrial biopsy identified atypical hyperplasia (AH) and/or endometrioid adenocarcinoma (EC). After ethics approval and informed consent, all women were treated with a combination of Luprolide acetate injections (3.75 or 11.25mg), Letrozole (2.5mg daily orally) and a progestin (Megase 80-160mg daily, Provera 20mg daily) or insertion of LNG-IUS) for 3 to 6 months.Results: Office endometrial biopsy at 3-6months, and/or hysteroscopic directed biopsies at 3-6 months, indicated inactive/decidualized endometrium with no residual AH or EC in all 5 patients. After two negative biopsies, 2 patients conceived 3 pregnancies resulting in 2 term deliveries and one 20-week loss. One woman is undergoing ART and the other two, at 44 and 46 years of age, are not trying for pregnancy.Conclusions: This novel combination medical treatment reverted endometrioid adenocarcinoma to normal in all 5 and allowed two term pregnancies in 2 women.
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