IUD May Treat Early Stage Uterine Cancer
The usual treatment for uterine cancer is a hysterectomy, but younger women who desire to one day become pregnant hope for options to preserve fertility. Italian researchers, who have published their results in the Annals of Oncology, have found that an intrauterine device or IUD may be an effective treatment to allow women to remain fertile longer and possibly have families.
Endometrial cancer affects about 40,000 women in the United States each year, according to the National Cancer Institute, and about 3 to 5 percent of women are under the age of 40. The majority of these women have not yet had children, according to background information in the article.
Dr. Lucas Minig, a gynecologic oncologist, and colleagues followed 20 Italian patients between the ages of 20 and 40 from January 1996 to June 2009 with atypical endometrial hyperplasia (AEH), and condition of abnormal cell growth that often precedes endometrial cancer, and 14 women with early stage cancer confined to the inner layer of the uterus. The women had an IUD known as Mirena inserted for one year which releases a progestin hormone called levonorgestrel. The women also received monthly injections of gonadotropin-releasing hormone (GnRH) for six months to halt estrogen production (estrogen encourages the development of cancer).
25% of Study Participants Successfully Had Healthy Babies
Ninety-five percent of women with AEH and 57% of women with diagnosed cancer responded completely to the treatment. Six patients later relapsed (four AEH patients and two cancer patients) and required further treatment, such as a hysterectomy, but at the end of the 10-year study, all women were alive and seemingly cancer-free, according to the authors. Nine of the women in the study successfully went on to become pregnant and have babies.
There were also fewer reports of side effects that often accompany oral hormone treatment, such as skin rashes, nausea and vomiting, headaches, and abnormal uterine bleeding. No adverse effects from the IUD treatment were noted in the report.
"It's a very important trial," said Dr. Angeles Alvarez Secord, associate professor of gynecologic oncology at Duke Comprehensive Cancer Center. "I've been using [the IUD] clinically for several years now for this purpose in patients who desire future fertility and some patients who cannot undergo surgery or who are at high risk for surgical complications. It's a fantastic alternative to treat patients with these diseases, and this study will help doctors when they discuss [treatment options] with patients."
Although the IUD is not yet approved to treat endometrial cancer, it is approved and widely used to treat endometriosis and abnormal uterine bleeding.
"Progestin intrauterine device and GnRH analogue for uterus-sparing treatment of endometrial precancers and well-differentiated early endometrial carcinoma in young women" L. Minig, D. Franchi, S. Boveri, C. Casadio, L. Bocciolone and M. Sideri, Ann Oncol (2010) doi: 10.1093/annonc/mdq463