While hysterectomy or removal of the uterus is the accepted treatment for this kind of cancer, doctors have been using the hormone in oral form for the past 20 years, but only for "well-selected groups of women," said Dr. Elizabeth Poynor, a gynecologic oncologist and pelvic surgeon with Lenox Hill Hospital in New York City. "Well selected," in this case, means those with early-stage disease who want to maintain their fertility, much like the group in this trial.
Oral hormone treatment to slow down the cancer's growth is a systemic therapy, however, and can have adverse side effects such as skin rashes, nausea and vomiting, headaches and abnormal uterine bleeding, according to background material accompanying the study.
The theoretical -- but still unproven -- advantage to this new IUD method, Poynor said, is that "there is a lower risk of systemic side effects . . . and that you may be giving higher doses of the drug directly into the uterus."
The authors followed 20 Italian patients from January 1996 to June 2009 with atypical endometrial hyperplasia (AEH), which often precedes the cancer, and 14 women with early-stage endometrial cancer confined to the inner layer of the womb.
Participants -- all of whom were between ages 20 and 40 -- had an IUD known as Mirena, which released levonorgestrel, inserted for a year. They also received monthly injections of gonadotropin-releasing hormone (GnRH), which halts estrogen production, for six months.
The IUD was removed at the end of the year if there was no evidence of cancer.
Ninety-five percent of women with AEH initially saw their lesions disappear completely, while 57.1 percent of women with early-stage cancer also responded completely to the treatment. (The disease progressed in one of the women with AEH and four of the women with early-stage cancer.)
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