Fertility preserving treatment with hysteroscopic resection followed by progestin therapy in young women with early endometrial cancer.
Fertility preserving treatment with hysteroscopic resection followed by progestin therapy in young women with early endometrial cancer.
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DOI：
10.3802/jgo.2017.28.e2
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发表时间：
2017-01
影响因子：
3.9
通讯作者：
Greggi S
中科院分区：
文献类型：
--
作者：
Falcone F;Laurelli G;Losito S;Di Napoli M;Granata V;Greggi S
报告15年来宫腔镜联合黄体酮治疗年轻早期子宫内膜癌（EC）患者保留生育能力的临床经验。28名希望保留生育能力的患者（IA期、G1期和2期子宫内膜样EC）被纳入这项前瞻性研究。采用宫腔镜切除肿瘤、瘤旁子宫内膜及瘤下肌层。辅助激素治疗包括口服醋酸甲孕酮或左炔诺孕酮宫内节育器6个月或更长时间。在黄体酮开始使用3个月后，25例（89.3%）患者表现为完全消退（至完全消退的中位时间为3个月[范围，3-9个月]），2例（7.1%）患者表现为持续性疾病，1例（3.6%）患者表现为疾病进展并接受了最终手术（IA期，G3子宫内膜样症）。6个月时，两名持续性疾病患者中的一名接受了最终手术（IA期，G1子宫内膜样症），而另一名成功再次治疗。2例复发（7.7%）均累及子宫内膜和同步卵巢癌。完全缓解的中位持续时间为94.5个月（范围8-175个月）。超过一半的应答者（57.7%）尝试怀孕，妊娠率和活产率分别为93.3%和86.6%。在黄体酮中加入标准化的三步切除术似乎可以提高黄体酮单独使用的疗效。在试图怀孕的妇女中观察到高怀孕率和活产率。
To report our 15-year institutional experience of fertility-sparing treatment in young patients with early endometrial cancer (EC) treated by combined hysteroscopic resection and progestin therapy. Twenty-eight patients (stage IA, G1 and 2 endometrioid EC) wishing to preserve their fertility were enrolled into this prospective study. Hysteroscopic resection was used to resect the tumor, endometrium adjacent to the tumor and myometrium underlying the tumor. Adjuvant hormonal therapy consisted of oral megestrol acetate or levonorgestrel intrauterine device for 6 months or more. After 3 months from the progestin start date, 25 patients (89.3%) showed a complete regression (median time to complete regression, 3 months [range, 3-9 months]), two (7.1%) showed persistent disease, while one patient (3.6%) presented with progressive disease and underwent definitive surgery (stage IA, G3 endometrioid). At 6 months, one of the two patients with persistent disease underwent definitive surgery (stage IA, G1 endometrioid), while the other one was successfully re-treated. Two recurrences were observed (7.7%) both involving the endometrium and synchronous ovarian cancer. The median duration of complete response was 94.5 months (range, 8-175 months). More than half of the responders (57.7%) attempted to conceive with 93.3% and 86.6% pregnancy and live birth rates, respectively. The addition of a standardized three-step resectoscopy to progestin would seem to improve the efficacy of progestin alone. High pregnancy and live birth rates were observed in women attempting to conceive.
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影响因子：
7.2
作者：
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通讯作者：
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作者：
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