Treatment Of Early Endometrial Cancer Research Articles

The role of minimally invasive surgery in gynaecological cancer: an overview of current trends.

The capabilities of minimally invasive surgery, either as conventional laparoscopy, or as robotic surgery, have increased to an extent that it enables complex operations in the field of gynaecological oncology. To document the role of minimally invasive gynaecological surgery in cancer. A review of the literature that shaped international guidelines and clinical practice. Current guidelines of major international scientific associations and trends in accepted clinical practice. In recent years, evidence on oncologic outcome has limited the role of minimally invasive techniques in cervical cancer, while the treatment of early endometrial cancer with laparoscopy and robotic surgery has become the international standard. In ovarian cancer, the role of minimally invasive surgery is still limited. Current evidence on perioperative morbidity underlines the necessity to implicate minimally invasive techniques whenever possible. The optimal surgical route for the treatment of gynaecological cancer remains in many cases controversial. The role of minimally invasive surgery remains increasing in the course of time. This comprehensive review offers an entire perspective on the current role of minimally invasive surgery in gynaecological cancer therapy.

Organ preservation treatment of patients with atypical hyperplasia and endometrial cancer: current trends

The high prevalence and steady increase in the incidence of endometrial cancer dictate the need to prevent and improve the effectiveness of treatment of this disease. The solution of these issues is possible either by expanding the indications for surgical treatment in endometrial proliferative processes, or by improving conservative methods of therapy, which is of priority importance, since some patients often have the question of preserving reproductive function.Leading oncogynecological communities have come to a consensus: conservative treatment with preservation of fertility is possible and safe for young patients with endometrioid endometrial cancer of a high degree of differentiation, limited to endometrial damage only. According to published studies, the use of progestins gives a high frequency response to treatment in patients with atypical hyperplasia and early endometrial cancer. Combined treatment methods, including the use of metformin or hysteroscopic resection after drug therapy, can reduce the frequency of relapses.In the absence of larger prospective studies, it is very important to consider a woman's overall health and fertility potential before recommending conservative treatment for early endometrial cancer. It is necessary to conduct further randomized controlled trials in order to provide more convincing evidence of the benefits of a particular technique.

Innovative Protocol of ART in Women with LNG-Ius for Fertility-Sparing Treatment of Endometrial Intraepithelial Neoplasia

<h3>Study Objective</h3> to evaluate the safety and efficacy of an Assisted Reproductive Technology (ART) program based on controlled ovarian stimulation with Levonorgestrel Intrauterine System (LNG-IUS) <i>in situ</i> in women affected by endometrial intraepithelial neoplasia<i>.</i> <h3>Design</h3> prospective observational study. <h3>Setting</h3> young women conservatively treated for FIGO IA G1 early endometrial cancer (EEC) and atypical endometrial hyperplasia (AEH) who underwent ART program with LNG-IUS <i>in situ</i>. <h3>Patients or Participants</h3> 6 patients undergoing conservative treatment for EEC (n=1) or AEH (n=5), from January 2019 to March 2021. <h3>Interventions</h3> patients with focal EEC were treated by hysteroscopic resection of the lesion according to Mazzon's technique; patients with AEH were treated by superficial endometrial resection preserving the basal layer of the endometrium. LNG-IUD was inserted in all patients after surgery. Patients were followed with histological evaluation at 3 months by endometrial biopsy, until two subsequent negative biopsies were obtained. At this time, controlled ovarian stimulation was started, oocytes retrieval was performed, and mature oocytes were cryopreserved. After removal of LNG-IUS, embryo transfer procedure was performed. Rates of oocytes retrieved, mature frozen oocytes and pregnancies were assessed. Rates of response and recurrence were also evaluated <h3>Measurements and Main Results</h3> out of 6 patients, 100% had a complete response and no subsequent relapse. Oocytes retrieved were 9.33±2.28 (mean±SD); mature oocytes were 7.5±1.89 (mean±SD). Embryo transfer was performed three months after the LNG-IUS removal. 4 pregnancies were obtained (66.67%),2(50%) of whom resulted in live birth, 1(25%) is still ongoing, 1(25%) resulted in a miscarriage in the first trimester. 2 patients (33.33%) experimented implantation failure and they are waiting for a further attempt <h3>Conclusion</h3> the presence of LNG-IUS during controlled ovarian stimulation has no detrimental effects on ovarian quality, while allowing to balance the potentially dangerous effect of hyperestrogenism on the endometrium of patients affected by AEH or EEC, with promising results about pregnancy outcomes.

The use of hysteroscopic endometrectomy in the conservative treatment of early endometrial cancer and atypical hyperplasia in fertile women.

To illustrate the effectiveness of hysteroscopic endometrial resection in conservative treatment of early endometrial cancer/atypical hyperplasia in women of reproductive age. Review of outcomes of women of reproductive age who underwent fertility sparing treatment (hysteroscopic superficial endometrectomy followed by progestin therapy) in early endometrial cancer. Eight women with Stage I endometrial cancer and three with atypical endometrial hyperplasia underwent hysteroscopic superficial endometrial resection, followed by 1-year treatment with oral megestrol acetate. One patient had a synchronous endometrioid ovarian carcinoma. One patient with Grade 2 carcinoma opted for conservative treatment and had hysterectomy 3months later for persisting disease. Ten patients showed no evidence of residual disease during a 12-month follow-up period with regular hysteroscopy. Five patients had seven pregnancies without assisted reproductive technology. One patient got pregnant after one attempt of in-vitro fertilization and oocyte donation. Pregnancy rate was 54.5%; two patients had two successful pregnancies and deliveries. Average time to pregnancy was 16months from the end of treatment. All babies were delivered vaginally. Total superficial endometrial resection followed by progestin can be considered in patients with early endometrial cancer/atypical hyperplasia who still want to conceive. It does not seem to impair fertility nor pregnancy outcomes in women of reproductive age.

Endometrial cancer with tubal metastasis detected during laparoscopic surgery in a patient undergoing fertility-sparing treatment with medroxyprogesterone acetate: a case report and review of the literature

Objectives: Medroxyprogesterone acetate (MPA) therapy is useful as a fertility-sparing treatment for early endometrial cancer, but it poses a risk of progression and recurrence during the treatment. We report a case of endometrial cancer with tubal metastases after long-term MPA therapy and review the literatures focusing on the failure of fertility-sparing treatment. Case: A nulliparous, 40 years old woman was started on MPA therapy after being diagnosed with grade 1 endometrioid carcinoma confined to the endometrium. She achieved complete remission after 10 months of treatment, but no pregnancy was established by assisted reproductive technology (ART). Eleven months after the first MPA therapy ended, atypical endometrial hyperplasia was confirmed. The disease was in remission again after the second MPA therapy for 8 months. The patient did not become pregnant by subsequent ART. Finally, a total laparoscopic hysterectomy with bilateral salpingo-oophorectomy was performed. The gross pathological specimen revealed a 13 mm mass near the left uterine cornu. Histopathology showed a left tube metastasis. She was diagnosed with FIGO stage IIIA endometrial cancer and underwent the staging surgery by laparotomy. After the second surgery, adjuvant chemotherapy was initiated. After 13 months of disease-free survival, a recurrence was histologically detected at the vaginal stump. Following intracavitary radiation therapy, there was no evidence of disease for 10 months. Conclusions: The patient undergoing fertility-sparing treatment should be apprised of a risk of life-threatening progression of the disease. Once the patient has opted out of fertility preservation, definitive hysterectomy should be strongly recommended.

Cost-effectiveness of robotic hysterectomy versus abdominal hysterectomy in early endometrial cancer

ObjectivesTo compare total costs for hospital stay and post-operative recovery between robotic and abdominal hysterectomy in the treatment of early-stage endometrial cancer provided in an enhanced recovery after surgery (ERAS)...

Cryoablation used in fertility-sparing treatment for early endometrial cancer: A pig model experiment using a new designed balloon cryoprobe

Young patients with early endometrial cancer have a strong desire to retain reproductive function, which require us to develop a therapeutic method that can not only assure the complete resection of tumor but also retain the uterine integrity. In the present study, we proposed a fertility-sparing surgery option that combined hysteroscopic resection with cryoablation to achieve this goal. To verify the safety and effectiveness of cryoablation for local uterine wall, we designed the experiment in pig model using a novel cryoablation balloon probe. In the process of freezing and thawing, the temperature of different parts of the uterus was measured in real time. The uterus was harvested immediately, three weeks after cryotherapy for histological evaluation. The results demonstrated cryoablation using the new cryoprobe is safe and effective. The effective freezing range can cover a range of 2 cm in diameter at least. This study provided us evidence before cryoablation could be applied in clinical practice of fertility-sparing treatment for young women with early endometrial cancer.

Learning curve and surgical outcomes for laparoscopic surgery, including pelvic lymphadenectomy, for early stage endometrial cancer.

The purpose of this study was to determine the learning curve of laparoscopic surgery for the treatment of early endometrial cancer and report the surgical outcomes. Patients: Data were retrospectively extracted from the medical charts of patients who underwent laparoscopic surgery. Laparoscopic surgery, including pelvic lymphadenectomy, was performed using the same technique and instruments for all patients. The learning curve for the surgical technique, characterized by the operative time, number of lymph nodes removed, and volume of intra-operative blood loss, was analyzed. Over the period of observation, 82 patients were enrolled. For analysis, cases were classified into four groups, based on their surgery date. Between-group comparisons identified a significant decrease in operative time and volume of blood loss between Groups 1 and 4 (P < 0.05). However, the number of lymph nodes removed, and the length of hospital stay were not influenced by learning. The operative time and the amount of blood loss significantly decreased with an increase in the surgeon's experience but with no effect of learning on the number of lymph nodes removed and length of hospital stay.

Возможности репродукции после лечения начального рака эндометрия

Возможности репродукции после лечения начального рака эндометрия

Hysteroscopic Endometrial Focal Resection followed by Levonorgestrel Intrauterine Device Insertion as a Fertility-Sparing Treatment of Atypical Endometrial Hyperplasia and Early Endometrial Cancer: A Retrospective Study

Study ObjectiveTo evaluate safety and effectiveness of the combination of hysteroscopic endometrial focal resection with levonorgestrel-releasing intrauterine device (LNG-IUD) for International Federation of Gynecology and Obstetrics stage IA G1 early endometrial cancer (EEC) and atypical endometrial hyperplasia (AEH) in young women to preserve their fertility. DesignRetrospective case series (Canadian Task Force classification II-3). SettingUniversity Federico II, Naples, Italy. PatientsThe medical records of 69 consecutive patients treated from 2007 to 2017 with diagnosis of EEC (n = 14) or AEH (n = 55) meeting inclusion criteria were reviewed. InterventionsPatients with focal EEC were treated by hysteroscopic resection of the lesion according to Mazzon's technique; patients with AEH were treated by superficial endometrial resection, preserving the basal layer of the endometrium. An LNG-IUD was inserted in all patients after surgery. Patients were followed for 24 months with serial hysteroscopic biopsies. Measurements and Main ResultsRates of response, live birth, and recurrence were assessed. Of the 14 patients with EEC, 11 (78.6%) achieved a complete response, 2 (18.2%) of whom had subsequent relapse, 1 (7.1%) showed partial response, whereas 2 (14.3%) were nonresponders (1 stable disease and 1 progression). Of the 55 patients with AEH, 51 (92.7%) achieved a complete response, 2 (3.9%) of whom had subsequent relapse, 3 (5.5%) showed partial response, whereas only 1 (1.8%) was nonresponder with stable disease. Among 25 patients who had removed the LNG-IUD, 10 (40%) gave birth after natural conception in the last 12 months of follow-up. ConclusionThe combination of hysteroscopic resection with an LNG-IUD as fertility-sparing treatment of EEC and AEH showed similar response and live birth rates compared with those reported in literature for progestins alone, but with considerably lower relapse rate. We advocate the use of this combined approach as an alternative fertility-sparing option in patients with ECC and AEH.

Retrospective Analysis of Intravaginal Brachytherapy in Adjuvant Treatment of Early Endometrial Cancer.

The aim of this study was to determine the role of adjuvant endovaginal brachytherapy HDR (High Dose Rate) or observation, as well as identification of risk factors of tumor recurrence. The study included 178 women after radical hysterectomy. All patients belonged to the group of low- and medium-risk stage I FIGO. Analysis consisted of 3-, 5-, and 10-year OS, DFS, and LRFS in both groups. Follow-up was more than 6.5 years. The 5-OS, 5-DFS, and 5-LRFS were 93%, 96%, and 98% in the treated group and 95%, 94%, and 96% in the observed group, respectively. These differences were not statistically significant. There was a statistically significant difference in 5-OS in the treated group, between low- and medium-risk subgroups (100% versus 87.55%, p = 0.018). There was a better prognosis among the patients with FIGO IA compared to FIGO IB (5-DFS, 97 versus 86%, p = 0.047). Among the risk factors, there were only statistically significant differences in the 5-OS, between the ages of ≤ 70 years and >70 years. Use of brachytherapy may affect the reduction in the number of local recurrences at the vaginal stump (6% versus 2%). This is particularly noticeable in the low-risk subgroup (9% versus 0%).

Comparison of fertility-sparing treatments in patients with early endometrial cancer and atypical complex hyperplasia: A meta-analysis and systematic review.

Background:There are some fertility-sparing treatments in patients with early endometrial cancer (EEC) or atypical complex hyperplasia (ACH), and the objective is to compare them by evaluating the oncologic and reproductive outcomes.Methods:We searched the published literature using Medline, Cochrane, EMBASE, and Google Scholar databases up to January 3, 2017, with various combinations of keywords fertility-sparing treatments, progesterone, progestin, intrauterine devices, early endometrial cancer, and atypical complex hyperplasia. The primary endpoint is the complete response (CR) rate, and the secondary endpoints are the partial response (PR) rate, relapse rate (RR), pregnancy rate, and live birth rate.Results:Twenty-eight studies containing 1038 women with EEC or ACH were included for review and meta-analysis. The results demonstrated that women with EEC or ACH managed with progestin had a pooled CR rate of 71% (95% confidence interval [CI]: 63–77%). The pooled pregnancy outcomes showed that 34% of women taking progestin treatment for EEC or ACH became pregnant (95% CI: 30–38%); however, only 20% of them delivered live newborns. The pooled CR rate for women using intrauterine device (IUD) was 76% (95% CI: 67–83%), and pooled RR was 9% (95% CI: 5–17%). The pregnancy rate for women whom underwent IUD was 18% (95% CI: 7–37%), and 14% of them delivered live newborns. In patients using progestin plus IUD, the pooled CR rate was 87% (95% CI: 75–93%); among those patients, 40% became pregnant (95% CI: 20–63%), and 35% delivered live newborns. There is no publication bias for the CR rate.Conclusion:For patients with EEC and ACH, treatments with progestin, with or without IUD, or IUD alone can reach good CR rate; however, the pregnancy outcomes might be worse in patients treated with IUD alone. Further randomized-controlled studies are warranted to find out a better solution.

A better model of care after surgery for early endometrial cancer - Comprehensive needs assessment and clinical handover to a woman's general practitioner.

Endometrial cancer is the most common invasive gynaecological cancer in Australia. Despite the fact that review after treatment of early endometrial cancer has not been shown to detect recurrent disease, practice at several hospitals brings women back for specialist hospital review for 5years after definitive cancer surgery. Implement an improved model of follow-up care following hospital treatment for early endometrial cancer. Quantitative and qualitative. Seventy-three of the eligible 81 women undertook the model of care. All general practitioners (GPs) agreed to follow-up care. Thirty-one women (42%) and 37 GPs (51%) returned surveys. All women found the nurse consultation very useful or useful with 77% reporting making lifestyle changes and 87% found the GP consultation very useful or useful with 72% reporting making lifestyle changes. Eighty-nine percent of GPs found the care plan useful, 94% set up patient recall systems, 79% used the care plan to develop their own care plan, 100% felt confident in providing follow-up care with 91% reporting the care plan and hospital processes improved their confidence. Comparison with the pre-cohort women showed: higher rates of communication at various care points to GPs (from P<0.001); more referrals (P<0.001); and a projected decrease of nine hospital doctor appointments per patient. With an increasing number of people surviving cancer, in order to address holistic health needs and maintain tertiary service capacity, general practice will be required to provide more follow-up care. Our model demonstrates an acceptable and quality mechanism for this to occur.

Single-access laparoscopic approach in the surgical treatment of endometrial cancer: A single-institution experience and review of literature.

BACKGROUND:The aim of this study was to assess the surgical and oncological outcome for the management of endometrial cancer (EC) by laparoendoscopic single-site surgery (LESS).PATIENTS AND METHODS:We performed a retrospective chart review of patients who underwent a LESS for EC. All the patients were treated by the same surgical team between July 2009 and June 2013 at the Gynaecologic Oncologic Unit, Regina Elena National Cancer Institute, Rome, Italy.RESULTS:A total of 50 women were included, with a median age of 45 years (range, 39-84 years) and a median body mass index (BMI) of 21.8 kg/m2 (range, 19-48 kg/m2). Median operative time was 100 min (range, 50-240 min), median blood loss was 90 mL (range, 10-300 mL) and median hospital stay was 3 days (range, 2-9 days). The median number of pelvic lymph nodes retrieved was 14 (range, 5-20). No intraoperative complications occurred, but there were 4 postoperative complications. Two patients required a laparoscopic conversion. The median follow-up was 36 months (range, 16-62 months) and no recurrence occurred.CONCLUSION:Our report showed that the LESS approach in the treatment of early EC can be a safe and reliable technique in terms of surgical and oncological outcomes.

Fertility-Sparing Treatment of Early Endometrial Cancer and Complex Atypical Hyperplasia in Young Women of Childbearing Potential.

To evaluate oncologic and reproductive outcome with levonorgestrel-releasing intrauterine system combined with gonadotropin-releasing hormone agonist in women with grade 1 endometrial carcinoma, and the levonorgestrel monotherapy in women with complex atypical hyperplasia. A prospective study was conducted. We analyzed the clinical characteristics of 70 patients younger than 42 years (mean age, 33 years) with a diagnosis of complex atypical endometrial hyperplasia (AEH) or grade 1 endometrial adenocarcinoma who were treated with hormonal therapy at the Division of Gynecologic Oncology of P.A. Hertsen Moscow Cancer Research Institute from February 2009 to December 2012. Patients with complex AEH received monotherapy with levonorgestrel-releasing intrauterine system (Mirena, Shering, Finland; 52 mg). Patients with a diagnosis of grade 1 endometrial cancer were treated with levonorgestrel-releasing intrauterine system combined with gonadotropin-releasing hormone agonist (Zoladex; AstraZeneca UK Limited, UK; 3.6-mg depot). All the patients received hormonal therapy for a minimum of 6 months. Pretreatment evaluation consisted of transabdominal and transvaginal ultrasound in grayscale, color Doppler ultrasound, contrast-enhanced magnetic resonance imaging, cervical hysteroscopy, Pipelle endometrial biopsy, and morphological and immunohistochemical characteristics of the tissue. Seventy patients were included in study analyses. Twenty three (72%) of 32 patients with adenocarcinoma and 35 (92%) of 38 patients with AEH had complete remission, defined as the absence of any carcinoma or hyperplasia on endometrial sampling specimens. Among these cases, 2 patients with adenocarcinoma and 1 patient with AEH had recurrence after their complete response. Nine patients had persistent disease. Eight patients had 10 conceptions, resulting in 8 live births. The suggested conservative treatment strategy can be considered as a valid therapeutic option for young women of childbearing potential with atypical endometrial hyperplasia and grade 1 endometrial adenocarcinoma who wish to preserve their fertility and thus may be recommended as an alternative to hysterectomy. Close follow-up during and after the treatment period is strictly required.

Successful pregnancy after conservative management of early stage endometrial carcinoma in a young nulliparous woman.

Successful pregnancy after conservative management of early stage endometrial carcinoma in a young nulliparous woman.

Steroid hormone intervenes in the endometrial tumorigenesis of pten ablation.

Background:Endometrial cancer, the most common gynecological cancer, is closely associated with endometrial hyperplasia, unopposed estrogen exposure, and genetic alterations. Phosphatase and tensin homologue (PTEN) is a tumor suppressor genes completely lost or mutated in >50% of primary endometrioid endometrial cancers. Estrogen-dependent endometrioid carcinoma is the most common type of endometrial cancer. Progesterone is a hormone that antagonizes the growth-promoting properties of estrogen in the uterus. Progestin is used as a conservative endocrine treatment of early endometrial cancer in order to preserve fertility as well as a palliative measure for advanced-stage patients. Progesterone therapy has been shown to be effective in preventing endometrial cancer as well as controlling growth of the endometrium. However, the effectiveness of progestin for women with endometrial cancer is less clear.Methods:In order to understand the effect of steroid hormone on endometrial cancer progression, we used a mouse endometrial cancer model with conditional loss of Pten in the mouse uterus (PRcre/+ Ptenf/f, Ptend/d). To assess the effect of steroid hormones, ovariectomized Ptenf/f and Ptend/d mice were treated with estrogen or progesterone over a period of three month.Results:Uterine weight gain was significantly decreased in ovariectomized PRcre/+ Ptenf/f mice compared to intact PRcre/+ Ptenf/f mice. Ovariectomized PRcre/+ Ptenf/f mice treated with P4 or vehicle also exhibited decreased uterine cancer size compared with intact PRcre/+ Ptenf/f mice. Proliferation of ovariectomized PRcre/+ Ptenf/f mice treated with P4 is highly decreased compared to other groups. The levels of stromal progesterone receptor were highly increased in ovariectomized PRcre/+ Ptenf/f mice treated with P4 which resulted in decreased epithelial proliferation.Conclusions:These results suggest that P4 treatment significantly reduces tumor mass but does not affect cancer progression in PRcre/+ Ptenf/f mice.

Long‐term outcomes after progestogen treatment for early endometrial cancer

For select women with early endometrial cancer, particularly nulliparous women, nonsurgical options may be considered. There is increasing experience using progestogens, but little is known about the long-term outcomes and safety of such treatment. To present the cancer and pregnancy outcomes of women with greater than five years follow-up after progestogen treatment for early endometrial cancer. Ten women who underwent greater than six months of continuous progestogen therapy for early endometrial cancer were included in the study. All were managed by a gynaecological oncologist at a major tertiary centre in Melbourne, Australia. The histology of each subsequent curette was recorded, as was the timing and histology of hysterectomy (if relevant), and the results of any subsequent pregnancies. All ten women showed histological regression of cancer with no cases of recurrence on follow-up curette. Four of ten women have undergone hysterectomy with one case of occult disease persistence in a woman noncompliant with therapy. The mean follow-up time was 89months (range 62-142months), there were no deaths and no woman was lost to follow-up. All four women attempting pregnancy were successful. There were eight pregnancies and five live births. This form of treatment appears to be successful and safe in the long term with good pregnancy outcomes. However, it is not standard and should be supervised in a specialised gynaecological oncology unit.

Conservative treatment of early endometrial cancer

Endometrial cancer is the most common cancer of the female genital tract in Europe and in the United States. Endometrial cancer has increased 21% in incidence since 2008, and the death rate has increased more than 100% over the past two decades. Approximately 15% of patients with endometrial cancer are pre-menopausal. The aim of this review is to discuss the conservative management of endometrial cancer. A number of studies largely support the conservative treatment of endometrial carcinoma (EC) in women desiring future fertility. We focus on the role of progestin hormonal therapy, including the risks associated with non-standard care, appropriate candidate selection, expected outcomes, various progestin agents and recommended follow-up.

Comparison of primary surgery versus definitive radiation for treatment of early endometrial cancer in the elderly population

Comparison of primary surgery versus definitive radiation for treatment of early endometrial cancer in the elderly population