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Pintwala R, Zhao L, Lee L, Rossman D. Metastasis of endometrial carcinoma to the ocular adnexa: a case report. Can J Ophthalmol 2022; 57:e213-e216. [DOI: 10.1016/j.jcjo.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 04/03/2022] [Accepted: 04/08/2022] [Indexed: 11/28/2022]
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Vlachos DE, Thomakos N, Haidopoulos D, Pergialiotis V, Theodoulidis V, Protopapas A, Rodolakis A. Ocular metastasis of primary gynecological malignancies, a rare but not insignificant entity: A systematic review. Niger J Clin Pract 2022; 25:739-746. [DOI: 10.4103/njcp.njcp_1763_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Thomakos N, Diakosavvas M, Machairiotis N, Fasoulakis Z, Zarogoulidis P, Rodolakis A. Rare Distant Metastatic Disease of Ovarian and Peritoneal Carcinomatosis: A Review of the Literature. Cancers (Basel) 2019; 11:cancers11081044. [PMID: 31344859 PMCID: PMC6721345 DOI: 10.3390/cancers11081044] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 07/09/2019] [Accepted: 07/22/2019] [Indexed: 12/11/2022] Open
Abstract
Background: Although metastases of ovarian and peritoneal carcinomatosis are most commonly found within the peritoneal cavity, there is a number of other rare distant sites that have been reported. Our goal is to provide an evidence-based summary of the available literature considering the rare distant metastatic sites of ovarian and peritoneal carcinomatosis. Methods: A comprehensive search of the literature was conducted, with Medline/PubMed being searched for cases of rare metastatic disease originated from primary ovarian and peritoneal cancer with related articles up to 2019 including terms such as "ovarian cancer", "metastases", "peritoneal" and others. Results: The most common mechanism of ovarian cancer metastases consists of primarily dissemination within the peritoneal cavity, while, rare and distant sites can either occur at the beginning or during the course of the disease and they are usually associated with hematogenous route and lymphatic invasion, having poor prognosis, with the least common sites being skin, bone, CNS, eye, placenta, central airways, rare lymph nodes, intra-abdominal organs, heart and breast. Conclusions: The occurrence of metastatic sites described in this review represents the most common rare distant metastatic sites, and even though their patterns of metastases are still not fully clarified due to the rarity of the reports, they offer valuable information considering the pathophysiology of the disease.
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Affiliation(s)
- Nikolaos Thomakos
- 1st Department of Obstetrics and Gynecology, Alexandra Hospital, Gynecologic Oncology Unit, University of Athens, Athens 115 28, Greece
| | - Michail Diakosavvas
- 1st Department of Obstetrics and Gynecology, Alexandra Hospital, Gynecologic Oncology Unit, University of Athens, Athens 115 28, Greece
| | - Nikolaos Machairiotis
- Department of Obstetrics & Gynecology, Department of Obstetrics-Gynaecology, Royal Oldham Hospital, Pennine Accute Trust, Oldham OL12JH, UK.
| | - Zacharias Fasoulakis
- 1st Department of Obstetrics and Gynecology, Alexandra Hospital, Gynecologic Oncology Unit, University of Athens, Athens 115 28, Greece
| | - Paul Zarogoulidis
- 3rd Department of Surgery, "AHEPA" University Hospital, Aristotle University of Thessaloniki, Thessaloniki 546 36, Greece
| | - Alexandros Rodolakis
- 1st Department of Obstetrics and Gynecology, Alexandra Hospital, Gynecologic Oncology Unit, University of Athens, Athens 115 28, Greece
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Loizzi V, Del Vecchio V, Crupano FM, Minicucci V, Fumarulo VV, Resta L, Vimercati A, Bettocchi S, Cicinelli E, Cormio G. A phase II study: dose-dense carboplatin and paclitaxel as neoadjuvant chemotherapy in locally advanced cervical cancer. J Chemother 2019; 30:247-252. [PMID: 30375951 DOI: 10.1080/1120009x.2018.1489601] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This study evaluates the efficacy and toxicity of dose-dense weekly paclitaxel and carboplatin as neoadjuvant chemotherapy in locally advanced cervical cancer (LACC). We collected 23 cases of LACC treated with weekly paclitaxel and carboplatin for nine cycles: 20 patients had complete or partial response to chemotherapy and were submitted to surgery, 3 with poor response received chemoradiation therapy. Pathologic examination showed complete response in four patients, myometrial invasion <50% in nine and >50% in seven patients, parametrial involvement in two, vaginal metastasis in one and lymphovascular space invasion, with positive margins, in another case. Despite seven patients had radiological evidence of lymph nodes involvement at diagnosis, only one had nodal metastases. Five patients showed grade 3-4 of hematologic toxicity.
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Affiliation(s)
- Vera Loizzi
- a Gynecologic Oncology Unit, Department of Biomedical Science and Human Oncology , University of Bari , Bari , Italy
| | - Vittoria Del Vecchio
- a Gynecologic Oncology Unit, Department of Biomedical Science and Human Oncology , University of Bari , Bari , Italy
| | - Francesco M Crupano
- a Gynecologic Oncology Unit, Department of Biomedical Science and Human Oncology , University of Bari , Bari , Italy
| | - Valentina Minicucci
- a Gynecologic Oncology Unit, Department of Biomedical Science and Human Oncology , University of Bari , Bari , Italy
| | - Valeria V Fumarulo
- a Gynecologic Oncology Unit, Department of Biomedical Science and Human Oncology , University of Bari , Bari , Italy
| | - Leonardo Resta
- b Department of Pathology , University of Bari , Bari , Italy
| | - Antonella Vimercati
- a Gynecologic Oncology Unit, Department of Biomedical Science and Human Oncology , University of Bari , Bari , Italy
| | - Stefano Bettocchi
- a Gynecologic Oncology Unit, Department of Biomedical Science and Human Oncology , University of Bari , Bari , Italy
| | - Ettore Cicinelli
- a Gynecologic Oncology Unit, Department of Biomedical Science and Human Oncology , University of Bari , Bari , Italy
| | - Gennaro Cormio
- a Gynecologic Oncology Unit, Department of Biomedical Science and Human Oncology , University of Bari , Bari , Italy.,c Gynecologic Oncology Unit, Department of Biomedical Science and Human Oncology , University of Bari, National Cancer Institute Bari , Bari , Italy
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A rare case of endometrial cancer metastatic to the uveal choroid. Gynecol Oncol Rep 2018; 23:24-27. [PMID: 29326973 PMCID: PMC5760249 DOI: 10.1016/j.gore.2018.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 12/28/2017] [Accepted: 01/02/2018] [Indexed: 11/29/2022] Open
Abstract
Choroid metastases are extremely rare in endometrial cancer. Choroid metastases can present as many different eye complaints. Comprehensive eye exams are important in patients with visual complaints.
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Greenwald ZR, Huang LN, Wissing MD, Franco EL, Gotlieb WH. Does hormonal therapy for fertility preservation affect the survival of young women with early-stage endometrial cancer? Cancer 2016; 123:1545-1554. [DOI: 10.1002/cncr.30529] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 11/09/2016] [Accepted: 12/06/2016] [Indexed: 12/16/2022]
Affiliation(s)
- Zoë R. Greenwald
- Division of Cancer Epidemiology; McGill University; Montreal Quebec Canada
- Department of Oncology; McGill University; Montreal Quebec Canada
| | - Lina N. Huang
- Department of Obstetrics and Gynecology; McGill University, Royal Victoria Hospital-Glen Site; Montreal Quebec Canada
| | - Michel D. Wissing
- Division of Cancer Epidemiology; McGill University; Montreal Quebec Canada
- Department of Oncology; McGill University; Montreal Quebec Canada
- Department of Urology; McGill University Health Center; Montreal Quebec Canada
| | - Eduardo L. Franco
- Division of Cancer Epidemiology; McGill University; Montreal Quebec Canada
- Department of Oncology; McGill University; Montreal Quebec Canada
| | - Walter H. Gotlieb
- Department of Oncology; McGill University; Montreal Quebec Canada
- Division of Gynecologic Oncology and Lady Davis Research Institute, Jewish General Hospital; Montreal Quebec Canada
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Long-Term Oncologic and Reproductive Outcomes in Young Women With Early Endometrial Cancer Conservatively Treated: A Prospective Study and Literature Update. Int J Gynecol Cancer 2016; 26:1650-1657. [PMID: 27654262 DOI: 10.1097/igc.0000000000000825] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
ObjectiveThis study aimed to analyze the long-term oncologic and reproductive outcomes in endometrial cancer (EC) in young patients conservatively treated by combined hysteroscopic resection (HR) and levonorgestrel intrauterine device (LNG-IUD).MethodsTwenty-one patients (age ≤ 40 years; Stage IA, G1-2 endometrioid EC), wishing to preserve their fertility, were enrolled into this prospective study. The HR was used to resect (1) the tumor lesion, (2) the endometrium adjacent to the tumor, and (3) the myometrium underlying the tumor. Hormonal therapy consisted of LNG-IUD (52 mg) for at least 6 months.ResultsThe median follow-up time is 85 months (range, 30–114). After 3 months from the progestin start date, 18 patients (85.7%) showed a complete regression (CR), 2 (9.5%) showed persistent disease, whereas 1 patient (4.8%) presented with progressive disease and underwent definitive surgery (Stage IA, G3 endometrioid). At 6 months, 1 of the 2 persistences underwent definitive surgery (Stage IA, G1 endometrioid), whereas the other was successfully re-treated. Two recurrences (10.5%) were observed, both involving the endometrium and synchronous ovarian cancer (OC) (atypical hyperplasia and Stage IIB G1 endometrioid OC; Stage IA endometrioid G1 EC, and Stage IA G1 endometrioid OC). The median duration of complete response was 85 months (range, 8–117). Sixty-three percent of complete responders attempted to conceive with 92% and 83% pregnancy and live birth rates, respectively. To date, all patients are alive and have no evidence of disease.ConclusionsAfter a long follow-up, combined HR and LNG-IUD would seem to improve the efficacy of progestin alone. High pregnancy and live birth rates were observed in women attempting to conceive. This approach is still experimental and should be offered only in the framework of scientific protocols conducted in cancer centers.
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Park JY, Nam JH. Progestins in the fertility-sparing treatment and retreatment of patients with primary and recurrent endometrial cancer. Oncologist 2015; 20:270-8. [PMID: 25673106 DOI: 10.1634/theoncologist.2013-0445] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Endometrial cancer is the most common gynecologic cancer in developed countries. Approximately 3%-14% of endometrial cancers are diagnosed in young women under 40 who want to preserve their fertility. The incidence of endometrial cancer in this age group is increasing, for which fertility-sparing therapy is increasingly used because it is one of the most important quality of life issues in these women. Progestin therapy is the most common type of fertility-sparing therapy. In this review, the most up-to-date findings regarding fertility-sparing progestin therapy for young women with primary and recurrent endometrial cancer is addressed in terms of diagnosis, treatment, follow-up, and oncologic and reproductive outcomes. Fertility-sparing progestin therapy is highly effective in selected young women with primary and recurrent endometrial cancer. The selection of appropriate patients through comprehensive pretreatment evaluation is of paramount importance to achieve the best outcomes without compromising survival. Because of the high rate of recurrence after successful fertility-sparing therapy, close surveillance is mandatory, and prophylactic hysterectomy is the best option for patients who have completed family planning. Pregnancy outcomes are very promising with the aid of assisted reproductive technologies. Continuous daily oral medroxyprogesterone acetate and megestrol acetate are the preferred progestins for fertility-sparing therapy, but future studies should be performed to determine the optimal dose and treatment duration of these agents.
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Affiliation(s)
- Jeong-Yeol Park
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Joo-Hyun Nam
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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Kalogera E, Dowdy SC, Bakkum-Gamez JN. Preserving fertility in young patients with endometrial cancer: current perspectives. Int J Womens Health 2014; 6:691-701. [PMID: 25114594 PMCID: PMC4122529 DOI: 10.2147/ijwh.s47232] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Endometrial cancer (EC) is the most common gynecologic malignancy in developed countries and affects predominantly postmenopausal women. It is estimated, however, that 15%–25% of women will be diagnosed before menopause. As more women choose to defer childbearing until later in life, the feasibility and safety of fertility-sparing EC management have been increasingly studied. Definitive treatment of total hysterectomy and bilateral salpingo-oophorectomy precludes future fertility and may thus be undesirable by women who wish to maintain their reproductive potential. However, the consideration of conservative management carries the oncologic risks of unstaged EC and the risk of missing a synchronous ovarian cancer. It is further complicated by the lack of consensus regarding the initial assessment, treatment, and surveillance. Conservative treatment with progestins has been shown to be a feasible and safe fertility-sparing approach for women with low grade, early stage EC with no myometrial invasion. The two most commonly adopted regimens are medroxyprogesterone acetate at 500–600 mg daily and megestrol acetate at 160 mg daily for a minimum of 6–9 months, with initial response rates commonly reported between 60% and 80% and recurrence rates between 25% and 40%. Photodynamic therapy and hysteroscopic EC excision have recently been reported as alternative approaches to progestin therapy alone. However, limited efficacy and safety data exist. Live birth rates after progestin therapy have typically been reported around 30%; however, when focusing only on those who do pursue fertility after successful treatment, the live birth rates were found to be higher than 60%. Assisted reproductive technology has been associated with a higher live birth rate compared with spontaneous conception, most likely reflecting the presence of infertility at baseline. Close follow-up is of paramount importance, and definitive treatment after completion of childbearing is advised.
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Affiliation(s)
| | - Sean C Dowdy
- Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN, USA
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Simpson AN, Feigenberg T, Clarke BA, Gien LT, Ismiil N, Laframboise S, Massey C, Ferguson SE. Fertility sparing treatment of complex atypical hyperplasia and low grade endometrial cancer using oral progestin. Gynecol Oncol 2014; 133:229-33. [PMID: 24561246 DOI: 10.1016/j.ygyno.2014.02.020] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 02/09/2014] [Accepted: 02/12/2014] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Oral progestin is an alternative to hysterectomy for women with complex atypical hyperplasia (CAH) or grade one endometrial cancer (G1EC) who wish fertility preservation. We evaluated treatment efficacy and fertility outcomes in this population. METHODS Women <45 y treated with oral progestin for CAH or G1EC were identified from two cancer centers. Data were obtained from medical records and telephone questionnaires. Time until complete response (CR), and from CR until recurrence was censored for patients without events and analyzed for associations with patient and treatment characteristics; cumulative incidence functions were used to estimate event probability over time. RESULTS 44 patients were identified, 19 (43%) with CAH and 25 (57%) with G1EC. Median age was 36.5 y (26-44). 24 (55%) achieved CR (median time: 5.7 months). Older age was associated with a lower likelihood of CR (HR 0.84, p=0.0003, 95% CI, 0.8-0.9). CR probability appeared to plateau after 12 months of therapy. Among those with CR, 13 (54%) recurred (median time 3.5 y). 24 patients (55%) underwent hysterectomy; 3 (13%) were upstaged. 11 (25%) underwent fertility treatment with the following outcomes: 6 (55%) no pregnancy, 2 (18%) at least one live infant, and 3 (27%) spontaneous abortion. One achieved a live birth without intervention. CONCLUSION Oral progestin is an effective temporizing fertility-sparing treatment for women with CAH/G1EC. Fertility specialist involvement is recommended due to the low live birth rate without intervention. Progestin therapy should be re-evaluated at 1 year in non-responders due to a low probability of success. Hysterectomy is recommended after childbearing due to a high recurrence rate.
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Affiliation(s)
- Andrea N Simpson
- Department of Obstetrics & Gynecology, University of Toronto, Division of Gynecologic Oncology, Princess Margaret Hospital/University Health Network, 610 University Ave M 700, Toronto, Ontario M5G 2M9, Canada.
| | - Tomer Feigenberg
- Department of Obstetrics & Gynecology, University of Toronto, Division of Gynecologic Oncology, Princess Margaret Hospital/University Health Network, 610 University Ave M 700, Toronto, Ontario M5G 2M9, Canada.
| | - Blaise A Clarke
- Department of Pathology and Laboratory Medicine, Toronto General Hospital/University Health Network, 11th Floor Eaton Wing, 200 Elizabeth St, Toronto, Ontario M5G 2C4, Canada.
| | - Lilian T Gien
- Department of Obstetrics & Gynecology, University of Toronto, Division of Gynecologic Oncology, Sunnybrook Health Sciences Centre, Odette Cancer Centre, T2-104, 2075 Bayview Ave, Toronto, Ontario M4N 3M5, Canada.
| | - Nadia Ismiil
- Department of Pathology and Laboratory Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, Ontario M4N 3M5, Canada.
| | - Stephane Laframboise
- Department of Obstetrics & Gynecology, University of Toronto, Division of Gynecologic Oncology, Princess Margaret Hospital/University Health Network, 610 University Ave M 700, Toronto, Ontario M5G 2M9, Canada.
| | - Christine Massey
- Independent Biostatistician, 93 George St. South, Ste 221, Brampton, Ontario L6Y 1P4, Canada.
| | - Sarah E Ferguson
- Department of Obstetrics & Gynecology, University of Toronto, Division of Gynecologic Oncology, Princess Margaret Hospital/University Health Network, 610 University Ave M 700, Toronto, Ontario M5G 2M9, Canada.
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Koskas M, Bendifallah S, Luton D, Daraï E, Rouzier R. Safety of uterine and/or ovarian preservation in young women with grade 1 intramucous endometrial adenocarcinoma: a comparison of survival according to the extent of surgery. Fertil Steril 2012; 98:1229-35. [DOI: 10.1016/j.fertnstert.2012.07.1142] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2012] [Revised: 07/28/2012] [Accepted: 07/31/2012] [Indexed: 10/27/2022]
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Park JY, Kim DY, Kim JH, Kim YM, Kim KR, Kim YT, Seong SJ, Kim TJ, Kim JW, Kim SM, Bae DS, Nam JH. Long-term oncologic outcomes after fertility-sparing management using oral progestin for young women with endometrial cancer (KGOG 2002). Eur J Cancer 2012; 49:868-74. [PMID: 23072814 DOI: 10.1016/j.ejca.2012.09.017] [Citation(s) in RCA: 134] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Revised: 09/12/2012] [Accepted: 09/15/2012] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To analyse the long-term oncologic outcomes of a fertility-sparing management using oral progestin in young women with endometrial cancer. METHODS We analysed 148 patients (age≤40 years) with stage IA, grade 1, endometrioid adenocarcinoma of the uterus who underwent fertility-sparing management using daily oral medroxyprogesterone acetate (MPA) or megestrol acetate (MA). RESULTS 115 (77.7%) showed complete response (CR) to progestin treatment, and 35 (30.4%) of them experienced recurrence after median follow-up time of 66 months. The 5-year recurrence-free survival was 68% (95% confidence interval [CI], 58.5-76.9%). However, 33 patients (22.3%) who failed to achieve CR underwent definitive surgical management, and no one had recurrence after median follow-up time of 41 months. During progestin treatment and at the time of recurrence, no patient showed clinical progression of disease over stage IA. Body mass index (BMI) ≥25 kg/m(2) was the only significant factor associated with a failure to achieve CR (odds ratio [OR], 3.00; 95% CI, 1.35-6.66; P=0.007). Upon multivariate analysis, BMI≥25 kg/m(2) (OR, 2.14; 95% CI, 1.06-4.31; P=0.033) was significantly associated with a higher risk of recurrence and the use of MPA (compared to MA) (OR, 0.44; 95% CI, 0.22-0.88; P=0.021), maintenance treatment (OR, 0.22; 95% CI, 0.05-0.94; P=0.042) and pregnancy (OR, 0.25; 95% CI, 0.11-0.56; P=0.001) were significantly associated with a lower risk of recurrence. CONCLUSION Fertility-sparing management was highly effective and safe. BMI<25 kg/m(2), MPA (compared to MA), maintenance treatment and pregnancy were associated with higher possibility of long-term success.
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Affiliation(s)
- Jeong-Yeol Park
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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A Turkish Gynecologic Oncology Group study of fertility-sparing treatment for early-stage endometrial cancer. Int J Gynaecol Obstet 2012; 119:270-3. [DOI: 10.1016/j.ijgo.2012.06.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 06/09/2012] [Accepted: 07/26/2012] [Indexed: 11/18/2022]
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Bakkum-Gamez JN, Kalogera E, Keeney GL, Mariani A, Podratz KC, Dowdy SC. Conservative Management of Atypical Hyperplasia and Grade I Endometrial Carcinoma: Review of the Literature and Presentation of a Series. J Gynecol Surg 2012. [DOI: 10.1089/gyn.2012.0011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - Gary L. Keeney
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Andrea Mariani
- Division of Gynecologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Karl C. Podratz
- Division of Gynecologic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Sean C. Dowdy
- Division of Gynecologic Surgery, Mayo Clinic, Rochester, Minnesota
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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; 125:477-82. [PMID: 22245711 DOI: 10.1016/j.ygyno.2012.01.003] [Citation(s) in RCA: 262] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Revised: 12/31/2011] [Accepted: 01/04/2012] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The objective of this review was to analyze published contemporary oncologic and reproductive outcomes in women with endometrial hyperplasia or cancer undergoing medical management with progestin therapy. METHODS A systematic review of oncologic and pregnancy outcomes in women with complex atypical hyperplasia or grade 1 adenocarcinoma was performed using a comprehensive search of the MEDLINE literature. English language studies published from 2004 to 2011 which utilized hormonal therapy were identified using key words endometrial hyperplasia, endometrial cancer, fertility preservation, hormone and progestin therapy. Fisher's exact test was used to calculate statistical differences. RESULTS Forty-five studies with 391 study subjects were identified. The median age was 31.7 years. Therapies included medroxyprogesterone (49%), megestrol acetate (25%), levonorgestrel intrauterine device (19%), hydroxyprogesterone caproate (0.8%), and unspecified/miscellaneous progestins (13.5%). Overall, 344 women (77.7%) demonstrated a response to hormonal therapy. After a median follow up period of 39 months, a durable complete response was noted in 53.2%. The complete response rate was significantly higher for those with hyperplasia than for women with carcinoma (65.8% vs. 48.2%, p=.002). The median time to complete response was 6 months (range, 1-18 months). Recurrence after an initial response was noted in 23.2% with hyperplasia and 35.4% with carcinoma during the study periods (p=.03). Persistent disease was observed in 14.4% of women with hyperplasia and 25.4% of women with carcinoma (p=.02). During the respective study periods, 41.2% of those with hyperplasia and 34.8% with a history of carcinoma became pregnant (p=.39), with 117 live births reported. CONCLUSION Based on this systematic review of the contemporary literature, endometrial hyperplasia has a significantly higher likelihood of response (66%) to hormonal therapy than grade 1 endometrial carcinoma (48%). Disease persistence is more common in women with carcinoma (25%) compared to hyperplasia (14%). Reproductive outcomes do not seem to differ between the cohorts.
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Affiliation(s)
- Camille C Gunderson
- Johns Hopkins Hospital, Department of Gynecology and Obstetrics, 600 North Wolfe Street, Phipps 279, Baltimore, MD 21287, USA.
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Traitement conservateur du cancer et des hyperplasies atypiques de l’endomètre en vue de préserver la fertilité : revue de la littérature. Bull Cancer 2012; 99:51-60. [DOI: 10.1684/bdc.2011.1516] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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18
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Laurelli G, Di Vagno G, Scaffa C, Losito S, Del Giudice M, Greggi S. Conservative treatment of early endometrial cancer: preliminary results of a pilot study. Gynecol Oncol 2010; 120:43-6. [PMID: 21040953 DOI: 10.1016/j.ygyno.2010.10.004] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Revised: 09/30/2010] [Accepted: 10/02/2010] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study evaluated the feasibility and efficacy of combined operative hysteroscopy (HSC) and hormone therapy as fertility-preserving treatment in a cohort of selected young women with early endometrial carcinoma (EC). METHODS Fourteen patients (median age 38 years, range 26-40) with FIGO stage IA (intramucous) EC wishing to preserve fertility were enrolled with the following inclusion criteria: age ≤40 years; no evidence of Lynch II syndrome; well-differentiated estrogen/progesterone receptor positive (ER+/PR+) endometrioid EC; no evidence of myoinvasion, multifocal tumor, node metastasis, ovarian mass; normal serum CA 125. Treatment consisted of hysteroscopic ablation of the lesion and the myometrial tissue below, followed by oral megestrol acetate (MA) 160 mg/day for 6 months (6 pts) or 52 mg levonorgestrel-medicated intrauterine device (LNG-IUD) for 12 months (8 pts). RESULTS With a median follow-up of 40 months (range 13-79), one patient recurred after 5 months from operative HSC and underwent definitive surgery, one patient showed an endometrial hyperplasia without atypia at the 3 and 6 month HSC control, with negative controls thereafter. Three patients have attempted to conceive and one of them conceived and term delivered a healthy baby. CONCLUSIONS Combined operative HSC and progestin therapy may have a role for safe and effective conservative management of early EC in selected patients wishing to preserve fertility.
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Affiliation(s)
- Giuseppe Laurelli
- Gynecologic Oncology, Istituto Nazionale dei Tumori G. Pascale, Naples, Italy
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Erkanli S, Ayhan A. Fertility-Sparing Therapy in Young Women With Endometrial Cancer. Int J Gynecol Cancer 2010; 20:1170-87. [DOI: 10.1111/igc.0b013e3181e94f5a] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Gadducci A, Spirito N, Baroni E, Tana R, Genazzani AR. The fertility-sparing treatment in patients with endometrial atypical hyperplasia and early endometrial cancer: a debated therapeutic option. Gynecol Endocrinol 2009; 25:683-91. [PMID: 19562604 DOI: 10.1080/09513590902733733] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Fertility-sparing treatment may represent a realist option for accurately selected young patients with endometrial atypical hyperplasia or well differentiated, early endometrial cancer. Oral progestins, and especially medroxyprogesterone acetate (MPA) and megestrol acetate with different doses and schedules, represent the most commonly used hormone agents in this clinical setting. Approximately three fourths of the women achieve a histologically documented complete response, with an mean response time of 12 weeks, but about one third of these subsequently developed a recurrence after a mean time of 20 months. The expression of receptor for progesterone receptor (PR), PTEN gene, DNA mismatch repair gene MLH1 and phospho-AKT on tissue specimens may be useful for selecting patients fit for a conservative management. Several successful pregnancies have occurred after a fertility-sparing treatment of endometrial atypical hyperplasia or endometrial cancer, more frequently with assisted reproductive technologies. The implementation of in vitro fertilisation techniques not only increases the chance of conception, but it may also decrease the interval to conception. The opportunity of a demolitive surgery after delivery or after childbearing being no longer required is a still debated issue. Large multicenter trials are strongly warranted to better define the selection criteria for a conservative treatment, endocrine regimen of choice, the optimal dosing, the duration of treatment and follow-up protocols. In any case, the patient should be accurately informed about the relatively high recurrence rates after complete response to hormone treatment and expectations for pregnancy.
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Affiliation(s)
- Angiolo Gadducci
- Department of Procreative Medicine, Division of Gynecology and Obstetrics, University of Pisa, via Roma 56, Pisa 56127, Italy.
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Thomakos N, Galaal K, Georgopoulos G, Nagaraju L, Hemming D, Naik R. Choroidal eye metastases from (recurrent) primary peritoneal carcinoma: case report and review of the literature. INTERNATIONAL SEMINARS IN SURGICAL ONCOLOGY 2009; 6:3. [PMID: 19154601 PMCID: PMC2633273 DOI: 10.1186/1477-7800-6-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2008] [Accepted: 01/20/2009] [Indexed: 11/10/2022]
Abstract
BACKGROUND Choroidal metastases from gynaecological primary are extremely rare. There is no documented case in the literature of choroid metastasis in a patient with primary peritoneal carcinoma (PPC). METHODS & RESULTS We describe the first case of a 54-year-old woman with a history of borderline mucinous tumour who presented 17 months later with PPC and 21 months after with recurrent disease metastatic to the eye, and review pertinent literature. CONCLUSION High index of suspicion is warranted when patients with history of primary peritoneal carcinoma present with visual complaints in order to treat and/or relieve symptomatology from metastatic eye disease.
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Affiliation(s)
- Nikolaos Thomakos
- Northern Gynaecological Oncology Centre, Gateshead Health NHS Trust, Queen Elizabeth Hospital, Sheriff Hill Gateshead NE9 6SX, UK.
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Sparing fertility in young patients with endometrial cancer. Gynecol Oncol 2008; 111:S101-4. [DOI: 10.1016/j.ygyno.2008.07.056] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2008] [Accepted: 07/09/2008] [Indexed: 11/17/2022]
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Akcaer M, Milman T, Finger PT. Imaging of endometrioid adenocarcinoma of the uterus metastatic to the ciliary body. Ophthalmic Surg Lasers Imaging Retina 2008; 39:246-9. [PMID: 18556953 DOI: 10.3928/15428877-20080501-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A 60-year-old woman with endometrioid adenocarcinoma (stage FIGO II) presented with left eye pain. A hysterectomy was to be preceded by pelvic radiation therapy (45 Gy). Ophthalmic examination with high frequency ultrasonography revealed a ciliary body tumor with iris extension. Positron emission tomography and computed tomography fusion revealed multifocal metastatic disease. A Finger iridectomy technique ciliary body tumor biopsy revealed metastatic endometrioid adenocarcinoma. Treatment with external beam radiation therapy (3,060 cGy in 17 daily fractions) resolved her ocular disease. Subsequent and rapidly evolving systemic carcinomatosis with brain involvement resulted in her death. This is the first reported case of endometrioid adenocarcinoma of the uterus metastatic to the uveal tract.
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Stage IV endometrial cancer after failed conservative management: a case report. Gynecol Oncol 2008; 111:579-82. [PMID: 18395778 DOI: 10.1016/j.ygyno.2008.02.027] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2007] [Revised: 02/24/2008] [Accepted: 02/27/2008] [Indexed: 11/21/2022]
Abstract
BACKGROUND With younger women becoming increasingly overweight, endometrial cancer is becoming a concern in this group. These women are likely to desire fertility preservation. There are no randomized controlled data to guide conservative therapy. CASE A 24-year-old female with endometrial adenocarcinoma diagnosed in December 2003 was treated conservatively with Megace and levonorgestrel intrauterine device. She was lost to follow-up and represented in March 2006. Endometrial biopsy revealed grade 1 endometrial adenocarcinoma. Definitive surgical therapy was recommended, however, the patient declined surgery in the interest of preserving fertility until November 2006. Final pathology revealed a stage IV, grade 1 endometrioid endometrial cancer. CONCLUSION Women with endometrial cancer who desire fertility preservation should be counseled regarding the possible risk of advanced disease if surgical therapy is delayed.
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Conservative management of patients with early endometrial carcinoma: a systematic review. Clin Transl Oncol 2008; 10:155-62. [DOI: 10.1007/s12094-008-0173-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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