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« Back to Contents ENDOMETRIAL CANCER
LiFE re
Literature for ENYGO
Treatment of endometrial hyperplasia (biology, conservative
and definitive treatment, follow-up)
Editor Kastriot Dallaku vs. 67.1 %, respectively) in 146 patients with EH without atypia. Emarh
found no significant difference between cyclic medroxyprogesterone
Descriptive summary acetate (MPA) and continuous MPA regimens in that group of patients,
although the first one was better tolerated by patients. Baek et al. fo-
An overview of the most relevant studies on the treatment of endo- cused on the role of oral progestin therapy as an alternative treatment
metrial hyperplasia covers two main aspects: for women with complex atypical hyperplasia (CAH) or early-stage EC
who desire fertility preservation. In their retrospective series 74.2 %
Diagnosis, biology and follow-up for patients with endomet- (23 of 31 patients) achieved complete remission.
rial hyperplasia.
Dominick et al. evaluated the effectiveness of LNG-IUS in their
Metin et al. studied 61 patients and reported that transvaginal systematic review of four trials with 543 women with breast cancer
elastosonography (ES) can help to distinguish between endometrial on adjuvant tamoxifen. The study confirmed the protective effect of
carcinoma (EC) and endometrial hyperplasia (EH) with a sensitivity of LNG-IUS in these patients, reducing the incidence of endometrial
81.3 %, a specificity of 100 %, a positive predictive value of 100 % polyps and hyperplasia.
and a negative predictive value of 70 %. ES has also been shown
in the study of Gultekin et al. to differentiate between pathological Ørbo et al. evaluated the risk of EH relapse within 2 years of ceasing
endometrial changes and normal endometrium in patients presenting therapy with either the LNG-IUS or oral MPA. Relapse rate was
with thickened endometrium. MR may also be suitable to differentiate similar in all groups and was independent of therapy regime. Mitsu-
between benign and malignant endometrial lesions (Shitano et al.). hashi et al., in their phase II study with 36 patients, demonstrated
that metformin (750-2250 mg/day) could prevent disease relapse
A systematic review and meta-analysis of 12 studies on endome- after combined therapy with MPA, as a fertility-sparing treatment for
trial sampling in postmenopausal bleeding was carried out by van atypical EH and EC.
Hanegem et al. Although specificity was very high, authors reported
a low sensitivity of endometrial sampling to detect both EC and Cholakian et al. demonstrated that oral progestin therapy compared
atypical EH. They concluded that after a benign result of endometrial with LNG-IUS for conservative treatment CAH or early-stage EC, was
biopsy, further diagnostic work is warranted. In their retrospective associated with increased weight gain. A systematic review by Wise
study Louie et al. suggested that endometrial thickness of <15mm et al. confirmed obesity to be a risk factor for CAH or EC in premeno-
without vaginal bleeding in postmenopausal women might not pausal women. Haggerty et al. reported that a 6-month lifestyle inter-
warrant endometrial sampling. vention via either telemedicine or text messaging resulted in weight
loss among obese women with endometrial hyperplasia and cancer.
Li et al. found Nup88 to be a potential biomarker for pre-malignant
lesions and early-stage EC (expressed in 91 % and 76 % of samples
respectively). Ørbo et al. studied the expression of PAX2 and PTEN
prior and after treatment with three different regimes of progestins
in EH. A levonorgestrel-impregnated intrauterine system (LNG-IUS)
was significantly more efficient compared to oral progestin therapy
in obtaining clearance of PAX2. Yang et al. studied PTEN expression
in relation to EC risk factors.
Conservative and definitive treatment for patients with endo-
metrial hyperplasia.
Treatment of endometrial hyperplasia, its risk of relapse and obesity
as risk factor were reported by several publications. Nooh et al.
reported that 6 months of treatment with depo-provera was more
successful in achieving regression than norethisterone acetate (91.8 %
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International Journal of Gynecological Cancer, Volume 26, Supplement #1 Page 21