An intrauterine device (IUD) that releases the progestin levonorgestrel was found to be an effective treatment option for women with early-stage endometrial cancer who were not good candidates for surgery.
The most common treatment for endometrial cancer is total hysterectomy, sometimes with removal of lymph nodes, explained study principal investigator Sharad Ghamande, MBBS, MD, a gynecologic surgeon and oncologist at Georgia Health Sciences University in Augusta, in a statement issued by the facility. However, surgery can be dangerous for women who are morbidly obese or who have cardiac risk factors.
Ghamande and his fellow researchers followed 5 patients with grade 1 endometrioid adenocarcinoma, a common subtype of endometrial cancer; 3 patients with grade 2 disease; and 7 patients with atypical endometrial hyperplasia, thickening of the uterine lining that can lead to cancer. All the women were morbidly obese or had severe comorbidities, and all underwent treatment with the levonorgestrel IUD, a commonly used contraceptive device, over the course of 2 years.
Transvaginal ultrasound performed before treatment and at the 3-month and 6-month marks measured endometrial stripes, or thickness of the endometrium. The progressive thinning of the endometrial stripes at each stage demonstrated the effectiveness of the IUD treatment. Subsequent endometrial biopsy found reversal of abnormal cell growth.
In addition to these findings, presented at the 14th Biennial Meeting of the International Gynecologic Cancer Society, held in Vancouver, Canada, October 13-16, 2012, and published in The International Journal of Gynecological Cancer (2012;22[8,Suppl 3]:E226), Ghamande’s team also conducted a meta-analysis of 13 published studies. A progestational IUD was used in the treatment of 147 atypical hyperplasias and 19 low-grade endometrial cancers. Complete pathological response was observed in 94.5% (157) of the 166 cases.
Given these results, the levonorgestrel IUD could lead to the development of a treatment for women with early-stage endometrial cancer that is cost-effective and lower-risk than hysterectomy.