ORİJİNAL ARAŞTIRMALAR
Atipik Hiperplazi/Endometrioid İntraepitelyal Neoplazi/Endometrial Kanserde Fertilite Koruyucu Tedavi: Bir Üçüncül Kanser Merkezi Deneyimi
Fertility-Sparing Treatment in Women with Atypical Hyperplasia/Endometrioid Intraepithelial Neoplasia/ Endometrial Cancer: A Tertiary Cancer Center Experience
Received Date : 27 Jun 2022
Accepted Date : 15 Sep 2022
Available Online : 26 Sep 2022
Canan KABACAa, Esra KELEŞ PEKERb, Burak GİRAYc, Mine GÜRAY UZUNb, Ugur Kemal ÖZTÜRKb
aMedipol University School of Medicine, Department of Gynecologic Oncology, Istanbul, Turkey
bUniversity of Health Sciences Turkey, Department of Gynecologic Oncology, Zeynep Kamil Training and Research Hospital, Istanbul, Turkey
cKoc University School of Medicine, Department of Gynecologic Oncology, Istanbul, Turkey
Doi: 10.24074/tjrms.2022-92149 - Makale Dili: EN
TJRMS. 2022;6(1):128-34
ÖZET
Amaç: Bu çalışma, endometriyal atipik hiperplazi (AH), endometrioid intraepitelyal neoplazi (EIN) ve endometrioid adenokarsinom (EC)
hastalarında fertilite koruyucu tedavi sonrası onkolojik ve obstetrik sonuçları değerlendirmeyi amaçlamaktadır. Gereç ve Yöntemler: Üçüncü
basamak bir jinekolojik kanser merkezinde Şubat 2014 ile Temmuz 2020 arasında fertilite koruyucu tedavi uygulanan AH/EIN ve EC'li hastaların
kayıtlarını geriye dönük olarak inceledik. Medyan takip süresi 52 (6-75) ay idi. Bulgular: Tam yanıt oranı %75.9 idi. EC'li hastaların tamamı
(n=2) 6 aylık tedaviden sonra stabil hastalığa sahipti. AH/EIN'li 27 hastanın 22'sinde (%81,5) 6-12 aylık tedaviden sonra tam yanıt alındı. AH/EIN
hastalarından ikisi grade 1 endometrioid endometrial kansere ilerledi ve AH/EIN hastalarının 3'ünde 6 aylık tedavi süresi boyunca stabil hastalık
vardı. AH/EIN grubundaki 13 (%59.1) hastada tam yanıt alma süresi ≤6 ay ve 9 (%40.9) hastada >6 ay idi. Tam yanıttan sonra AH/EIN olan bir
hasta spontan gebe kaldı ve sağlıklı bir doğum yaptı. Nüks oranı %9.1 idi. Sonuç: Endometrial karsinom veya düşük dereceli endometrium
kanseri öncü lezyonları olan ve fertilitesini korumak isteyen kadınlarda fertilite koruyucu tedavi modaliteleri yakın takiple uygulanabilir.
Anahtar Kelimeler: Atipik hiperplazi; endometrial kanser; endometrioid intraepitelyal neoplazi; fertilite koruyucu
ABSTRACT
Objective: The present study aims to evaluate the oncological and obstetric outcomes after fertility-sparing treatment in patients with endometrial
atypical hyperplasia (AH), endometrioid intraepithelial neoplasia (EIN), and endometrioid adenocarcinoma (EC). Materials and Methods:
We retrospectively analyzed the records of patients with AH/EIN and EC who underwent fertility-preserving treatment in a tertiary gynecological
cancer center between February 2014 and July 2020. The median follow-up was 52 (range, 6-75) months. Results: The complete response
rate was 75.9%. All of the patients with EC (n=2) had stable disease after the treatment of 6 months. Twenty-two (81.5%) patients of 27 patients
with AH/EIN had a complete response after the treatment of 6-12 months. Two of AH/EIN patients progressed to grade 1 endometrioid endometrial
cancer, and 3 of AH/EIN patients had stable disease during the 6-month treatment period. The time to complete response was ≤6 months
in 13 (59.1%) and >6 months in 9 (40.9%) patients in the AH/EIN group. One patient with AH/EIN after complete response became pregnant
spontaneously and she gave a healthy birth. The recurrence rate was 9.1%. Conclusion: Fertility-sparing treatment modalities could be feasible
in women with precursor lesions of endometrial carcinoma or low-grade endometrial cancer who want to preserve their fertility within close follow-
up.
Keywords: Atypical hyperplasia; endometrial cancer; endometrioid intraepithelial neoplasia; fertility-sparing
REFERANSLAR
- Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018;68(6):394-424. [Crossref] [PubMed]
- Corzo C, Barrientos Santillan N, Westin SN, Ramirez PT. Updates on conservative management of endometrial cancer. J Minim Invasive Gynecol 2018;25(2):308-13. [Crossref] [PubMed]
- Soliman PT, Oh JC, Schmeler KM, Sun CC, Slomovitz BM, Gershenson DM, et al. Risk factors for young premenopausal women with endometrial cancer. Obstet Gynecol 2005;105(3):575-80. [Crossref] [PubMed]
- Arendas K, Aldossary M, Cipolla A, Leader A, Leyland NA. Hysteroscopic resection in the management of early-stage endometrial cancer: report of 2 cases and review of the literature. J Minim Invasive Gynecol 2015;22(1):34e9. [Crossref] [PubMed]
- Pronin SM, Novikova OV, Andreeva JY, Novikova EG. Fertility-sparing treatment of early endometrial cancer and complex atypical hyperplasia in young women of childbearing potential. Int J Gynecol Cancer 2015;25:1010-4. [Crossref] [PubMed]
- Chen M, Jin Y, Li Y, Bi Y, Shan Y, Pan L. Oncologic and reproductive outcomes after fertility-sparing management with oral progestin for women with complex endometrial hyperplasia and endometrial cancer. Int J Gynaecol Obstet 2016;132(1):34-8. [Crossref] [PubMed]
- Gunderson CC, Fader AN, Carson KA, Bristow RE. Oncologic and reproductive outcomes with progestin therapy in women with endometrial hyperplasia and grade 1 adenocarcinoma: a systematic review. Gynecol Oncol 2012;125(2):477-82. [Crossref] [PubMed]
- Perri T, Korach J, Gotlieb WH, et al. Prolonged conservative treatment of endometrial cancer patients: more than 1 pregnancy can be achieved. Int J GynecolCancer 2011;21:72-8. [Crossref] [PubMed]
- Bovicelli A, D'Andrilli G, Giordano A, De Iaco P. Conservative treatment of early endometrial cancer. J Cell Physiol 2013;228:1154-8. [Crossref] [PubMed]
- Chiva L, Lapuente F, González-Cortijo L, et al. Sparing fertility in young patients with endometrial cancer. Gynecol Oncol 2008;111(2 Suppl):S101-4. [Crossref] [PubMed]
- Bakkum-Gamez J, Kalogera E, Keeney G, Mariani A, Podratz K, Dowdy S. Conservative management of atypical hyperplasia and grade I endometrial carcinoma: Review of the literature and presentation of a series. J Gynecol Surg 2012;28:262-9. [Crossref]
- Koskas M, Uzan J, Luton D, Rouzier R, Daraï E. Prognostic factors of oncologic and reproductive outcomes in fertility-sparing management of endometrial atypical hyperplasia and adenocarcinoma: systematic review and meta-analysis. Fertil Steril 2014;101(3):785-94. [Crossref] [PubMed]
- Ramirez PT, Frumovitz M, Bodurka DC, Sun CC, Levenback C. Hormonal therapy for the management of grade 1 endometrial adenocarcinoma: a literature review. Gynecol Oncol 2004;95(1):133-8. [Crossref] [PubMed]
- Orbo A, Vereide A, Arnes M, Pettersen I, Straume B. Levonorgestrel-impregnated intrauterine device as treatment for endometrial hyperplasia: a national multicentre randomised trial. BJOG 2014;121(4):477-86. [Crossref] [PubMed] [PMC]
- Cade TJ, Quinn MA, Rome RM, Neesham D. Progestogen treatment options for early endometrial cancer. BJOG 2010;117(7):879-84. [Crossref] [PubMed]
- Eftekhar Z, Izadi-Mood N, Yarandi F, Shojaei H, Rezaei Z, Mohagheghi S. Efficacy of megestrol acetate (megace) in the treatment of patients with early endometrial adenocarcinoma: our experiences with 21 patients. Int J Gynecol Cancer 2009;19(2):249-52. [Crossref] [PubMed]
- Ayhan A, Tohma YA, Tunc M. Fertility preservation in early-stage endometrial cancer and endometrial intraepithelial neoplasia: A single-center experience. Taiwan J Obstet Gynecol 2020;59(3):415-9. [Crossref] [PubMed]
- Walsh C, Holschneider C, Hoang Y, Tieu K, Karlan B, Cass I. Coexisting ovarian malignancy in young women with endometrial cancer. Obstet Gynecol 2005;106:693-9. [Crossref] [PubMed]
- Morice P, Fourchotte V, Sideris L, Gariel C, Duvillard P, Castaigne D. A need for laparoscopic evaluation of patients with endometrial carcinoma selected for conservative treatment. Gynecol Oncol 2005;96(1):245-8. [Crossref] [PubMed]
- Navarria I, Usel M, Rapiti E, et al. Young patients with endometrial cancer: how many could be eligible for fertility-sparing treatment? Gynecol Oncol 2009;114(3):448-51. [Crossref] [PubMed]
- Shikeli S, Gowri V, Rawahi TA. Fertility-sparing treatment in young women with atypical endometrial hyperplasia and low-grade endometrial cancer: A tertiary center experience. JBRA Assist Reprod 2020;24(4):466-9. [Crossref] [PubMed] [PMC]
