Falcone Francesca, Laurelli Giuseppe, Losito Simona, Di Napoli Marilena, Granata Vincenza, Greggi Stefano
Gynecologic Oncology Surgery, National Cancer Institute of Naples-IRCCS "Fondazione G. Pascale", Naples, Italy.
Department of Woman, Child, and General and Specialized Surgery, Second University of Naples, Naples, Italy.
J Gynecol Oncol. 2017 Jan;28(1):e2. doi: 10.3802/jgo.2017.28.e2. Epub 2016 Aug 8.
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.
报告我们15年来对早期子宫内膜癌（EC）年轻患者采用宫腔镜切除术联合孕激素治疗进行保留生育功能治疗的机构经验。
28例希望保留生育功能的患者（IA期，G1和G2级子宫内膜样EC）纳入这项前瞻性研究。采用宫腔镜切除术切除肿瘤、肿瘤相邻的子宫内膜和肿瘤下方的肌层。辅助激素治疗包括口服醋酸甲地孕酮或左炔诺孕酮宫内节育器，持续6个月或更长时间。
从开始使用孕激素起3个月后，25例患者（89.3%）显示完全缓解（完全缓解的中位时间为3个月[范围3 - 9个月]），2例（7.1%）显示疾病持续存在，1例患者（3.6%）出现疾病进展并接受了根治性手术（IA期，G3级子宫内膜样癌）。6个月时，2例疾病持续存在的患者中有1例接受了根治性手术（IA期，G1级子宫内膜样癌），另1例成功接受了再次治疗。观察到2例复发（7.7%），均累及子宫内膜并伴有同步性卵巢癌。完全缓解的中位持续时间为94.5个月（范围8 - 175个月）。超过一半的缓解者（57.7%）尝试受孕，妊娠率和活产率分别为93.3%和86.6%。
在孕激素治疗基础上增加标准化的三步宫腔镜切除术似乎可提高单纯孕激素治疗的疗效。尝试受孕的女性中观察到较高的妊娠率和活产率。
