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Intrauterine progesterone treatment of early endometrial cancer

  • Fredrick J. Montz
    Affiliations
    Kelly Gynecologic Oncology Service, Departments of Gynecology and Obstetrics and Oncology, and the Division of Gynecologic Pathology, Department of Pathology, Johns Hopkins Hospital and Medical Institutions. Baltimore, Md
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  • Robert E. Bristow
    Affiliations
    Kelly Gynecologic Oncology Service, Departments of Gynecology and Obstetrics and Oncology, and the Division of Gynecologic Pathology, Department of Pathology, Johns Hopkins Hospital and Medical Institutions. Baltimore, Md
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  • Alessandro Bovicelli
    Affiliations
    Kelly Gynecologic Oncology Service, Departments of Gynecology and Obstetrics and Oncology, and the Division of Gynecologic Pathology, Department of Pathology, Johns Hopkins Hospital and Medical Institutions. Baltimore, Md
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  • Rafael Tomacruz
    Affiliations
    Kelly Gynecologic Oncology Service, Departments of Gynecology and Obstetrics and Oncology, and the Division of Gynecologic Pathology, Department of Pathology, Johns Hopkins Hospital and Medical Institutions. Baltimore, Md
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  • Robert J. Kurman
    Affiliations
    Kelly Gynecologic Oncology Service, Departments of Gynecology and Obstetrics and Oncology, and the Division of Gynecologic Pathology, Department of Pathology, Johns Hopkins Hospital and Medical Institutions. Baltimore, Md
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      Abstract

      Objective: Our purpose was to assess the feasibility of using a progesterone-containing intrauterine device (IUD) to treat presumed Federation Internationale Gynecologie et d'Obstetrique (FIGO) stage IA, grade 1 endometrioid cancer in women at high risk for perioperative complications. Study design: Candidates were women with American Society of Anesthesiologists class III or IV grade 1 endometrioid cancer and no imaging evidence of myometrial invasion. Subjects underwent hysteroscopy, curettage, and IUD placement, followed by endometrial biopsy every 3 months for 1 year. The records of similar patients treated surgically during the 3 years before protocol initiation were reviewed for comparison. Results: Sixteen patients fulfilled study criteria. Fourteen consented to participation; one was excluded at the time of IUD placement (grade 2 disease identified) and one was lost to follow-up. Twelve subjects have been followed up to 36 months; results of biopsies were negative in 7 of 11 at 6 months and 6 of 8 at 12 months. No IUD-related complications, except for expulsion, occurred. Sixteen complications (one fatal) occurred in 9 of the 15 control patients. Conclusion: Intrauterine progesterone appears to eradicate some cases of presumed stage IA, grade 1 endometrioid cancer in women at high risk for perioperative morbidity. (Am J Obstet Gynecol 2002;186:651-7.)

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