An intrauterine device (IUD) is an effective tool in the treatment of early-stage endometrial cancer in certain patients, according to the results of a small study presented at the International Gynecological Cancer Society’s 14th biennial meeting in Vancouver last month.1
Researchers at the Georgia Health Sciences University Cancer Center followed a small group of women with either early-stage endometrioid adenocarcinoma (n = 8) or atypical endometrial hyperplasia (n = 7) diagnosed using hysteroscopy, dilatation, and curettage. All participants were considered high-risk surgical candidates because they were either morbidly obese or had significant cardiovascular risk factors. The study patients received treatment for their condition with a commonly used implantable contraception—an IUD that released progestin levonorgestrel—and were followed for 2 years.
To determine whether the IUD was an effective treatment of endometrioid adenocarcinoma or endometrial hyperplasia, researchers measured the endometrial stripe, or the thickness of the endometrium, using transvaginal ultrasound before the study and again at 3 months and 6 months. Progressive thinning of the endometrium was noted at each stage in all patients, a finding that demonstrates treatment effectiveness, according to the researchers. The mean pretreatment endometrial stripe measured 11.25 millimeters, and the post-treatment endometrial stripe measured 5.19 millimeters.1
To confirm the ultrasonographic findings, endometrial biopsy was performed; the results of the biopsy showed a “reversal of abnormal cell growth, or neoplastic changes, in all patients,” according to the press release.2 These findings validate the use of transvaginal ultrasound as a useful tool for follow-up assessment of endometrial cancer treatment, concluded the study authors.
The researchers also analyzed 13 previously published studies involving the use of progestational IUDs in 166 women with low-grade endometrial cancer or atypical hyperplasia. The findings of this analysis showed that 157 (95.4%) of 166 cases completely resolved with treatment and without disease progression.1
“Thirty percent to 35% of women with hyperplasia will go on to develop endometrial cancer, and in 30% of these cases, women will present with a co-existing cancer,” said Sharad Ghamande, MBBS, MD, principal investigator of the study.2 “Traditional treatments can result in postoperative complications and morbidity, not only in patients at high risk. But we may succeed in establishing a lower-risk and more cost-effective way of managing this cancer in all women.”
- Levonorgestrel IUD is an effective treatment option for morbidly obese and other high-risk surgical patients.
- Transvaginal ultrasound is a useful follow-up tool for the evaluation of the endometrial stripe.