J Gynecol Oncol.  2019 Jul;30(4):e57. 10.3802/jgo.2019.30.e57.

Efficacy and fertility outcomes of levonorgestrel-releasing intra-uterine system treatment for patients with atypical complex hyperplasia or endometrial cancer: a retrospective study

• Leone Roberti Maggiore U
• Martinelli F
• Dondi G
• Bogani G
• Chiappa V
• Evangelista MT
• Liberale V
• Ditto A
• Ferrero S
• Raspagliesi F

• KMID: 2450236
• DOI: http://doi.org/10.3802/jgo.2019.30.e57

Abstract

OBJECTIVE
To investigate the efficacy of levonorgestrel-releasing intra-uterine system (LNG-IUS) treatment in patients affected by atypical complex hyperplasia/endometrial cancer (ACH/EC) wishing to preserve their fertility and to present fertility outcomes of those patients who actively tried to conceive.
METHODS
Data of consecutive women with ACH/EC who underwent fertility-sparing treatment using LNG-IUS were retrospectively evaluated.
RESULTS
Overall, 48 patients and the mean (±standard deviation) length of follow-up was 82.6±47.2 months. Among patients with ACH, 25/28 (89.3%) had a complete response (CR), 2/28 (7.1%) had a partial response (PR) and 1/28 (3.6%) had a progressive disease (PD). Mean (±standard deviation) time to CR was 6.7±4.0 months. Among patients with G1 EC, 13/16 (81.3%) had a CR, 1/16 (6.3%) had a PR and 2/16 (12.5%) had a PD. Mean (±standard deviation) time to CR was 5.0±2.9 months. Among patients with G2 EC, 3/4 (75.0%) had a CR and 1/4 (25.0%) had a PD. Mean (±standard deviation) time to CR was 4.0±0 months. Only 19 (39.6%) patients who had CR actually attempted to conceive. Eleven (57.9%) women tried to conceive naturally while 8 (42.1%) women underwent an in vitro fertilization (IVF). Fourteen (73.7%) patients wishing to conceive achieved a pregnancy (6 spontaneously and 8 through IVF).
CONCLUSIONS
Fertility-sparing treatment of patient with ACH/EC with LNG-IUS achieves high regression rates and good fertility outcomes. Future larger multi-institutional studies should be designed to confirm these preliminary findings.

Keyword

Endometrial Cancer; Fertility; Hyperplasia; Levonorgestrel; Pregnancy

MeSH Terms

Endometrial Neoplasms*
Female
Fertility*
Fertilization in Vitro
Follow-Up Studies
Humans
Hyperplasia*
Levonorgestrel
Pregnancy
Retrospective Studies*
Levonorgestrel