Atipik Hiperplazi/Endometrioid İntraepitelyal Neoplazi/Endometrial Kanserde Fertilite Koruyucu Tedavi: Bir Üçüncül Kanser Merkezi Deneyimi
Fertility-Sparing Treatment in Women with Atypical Hyperplasia/Endometrioid Intraepithelial Neoplasia/ Endometrial Cancer: A Tertiary Cancer Center Experience
Received Date : 27 Jun 2022
Accepted Date : 15 Sep 2022
Available Online : 26 Sep 2022
Canan KABACAa, Esra KELEŞ PEKERb, Burak GİRAYc, Mine GÜRAY UZUNb, Ugur Kemal ÖZTÜRKb
aMedipol University School of Medicine, Department of Gynecologic Oncology, Istanbul, Turkey
bUniversity of Health Sciences Turkey, Department of Gynecologic Oncology, Zeynep Kamil Training and Research Hospital, Istanbul, Turkey
cKoc University School of Medicine, Department of Gynecologic Oncology, Istanbul, Turkey
Doi: 10.24074/tjrms.2022-92149 - Makale Dili: EN
TJRMS. 2022;6(1):128-34
ÖZET
Amaç: Bu çalışma, endometriyal atipik hiperplazi (AH), endometrioid intraepitelyal neoplazi (EIN) ve endometrioid adenokarsinom (EC)
hastalarında fertilite koruyucu tedavi sonrası onkolojik ve obstetrik sonuçları değerlendirmeyi amaçlamaktadır. Gereç ve Yöntemler: Üçüncü
basamak bir jinekolojik kanser merkezinde Şubat 2014 ile Temmuz 2020 arasında fertilite koruyucu tedavi uygulanan AH/EIN ve EC'li hastaların
kayıtlarını geriye dönük olarak inceledik. Medyan takip süresi 52 (6-75) ay idi. Bulgular: Tam yanıt oranı %75.9 idi. EC'li hastaların tamamı
(n=2) 6 aylık tedaviden sonra stabil hastalığa sahipti. AH/EIN'li 27 hastanın 22'sinde (%81,5) 6-12 aylık tedaviden sonra tam yanıt alındı. AH/EIN
hastalarından ikisi grade 1 endometrioid endometrial kansere ilerledi ve AH/EIN hastalarının 3'ünde 6 aylık tedavi süresi boyunca stabil hastalık
vardı. AH/EIN grubundaki 13 (%59.1) hastada tam yanıt alma süresi ≤6 ay ve 9 (%40.9) hastada >6 ay idi. Tam yanıttan sonra AH/EIN olan bir
hasta spontan gebe kaldı ve sağlıklı bir doğum yaptı. Nüks oranı %9.1 idi. Sonuç: Endometrial karsinom veya düşük dereceli endometrium
kanseri öncü lezyonları olan ve fertilitesini korumak isteyen kadınlarda fertilite koruyucu tedavi modaliteleri yakın takiple uygulanabilir.
Anahtar Kelimeler: Atipik hiperplazi; endometrial kanser; endometrioid intraepitelyal neoplazi; fertilite koruyucu
ABSTRACT
Objective: The present study aims to evaluate the oncological and obstetric outcomes after fertility-sparing treatment in patients with endometrial
atypical hyperplasia (AH), endometrioid intraepithelial neoplasia (EIN), and endometrioid adenocarcinoma (EC). Materials and Methods:
We retrospectively analyzed the records of patients with AH/EIN and EC who underwent fertility-preserving treatment in a tertiary gynecological
cancer center between February 2014 and July 2020. The median follow-up was 52 (range, 6-75) months. Results: The complete response
rate was 75.9%. All of the patients with EC (n=2) had stable disease after the treatment of 6 months. Twenty-two (81.5%) patients of 27 patients
with AH/EIN had a complete response after the treatment of 6-12 months. Two of AH/EIN patients progressed to grade 1 endometrioid endometrial
cancer, and 3 of AH/EIN patients had stable disease during the 6-month treatment period. The time to complete response was ≤6 months
in 13 (59.1%) and >6 months in 9 (40.9%) patients in the AH/EIN group. One patient with AH/EIN after complete response became pregnant
spontaneously and she gave a healthy birth. The recurrence rate was 9.1%. Conclusion: Fertility-sparing treatment modalities could be feasible
in women with precursor lesions of endometrial carcinoma or low-grade endometrial cancer who want to preserve their fertility within close follow-
up.
Keywords: Atypical hyperplasia; endometrial cancer; endometrioid intraepithelial neoplasia; fertility-sparing