Progestin-releasing intrauterine device insertion plus palliative radiotherapy in frail, elderly uterine cancer patients unfit for radical treatment

• Published in: Oncology letters Vol. 11; no. 5; pp. 3446 - 3450
• Main Authors: MACCHIA, GABRIELLA, DEODATO, FRANCESCO, CILLA, SAVINO, LEGGE, FRANCESCO, CARONE, VITO, CHIANTERA, VITO, VALENTINI, VINCENZO, MORGANTI, ALESSIO GIUSEPPE, FERRANDINA, GABRIELLA
• Format: Journal Article
• Language: English
• Published: Greece D.A. Spandidos 01-05-2016; Spandidos Publications; Spandidos Publications UK Ltd
• Subjects: Aged patients; Anemia; Antigens; Body mass index; Cancer therapies; Care and treatment; Diarrhea; elderly; Endometrial cancer; Frailty; Gynecology; Hypertension; Intrauterine contraceptives; Intrauterine devices; IUD; Laboratories; Methods; Oncology; palliative radiotherapy; Palliative treatment; Patients; Physiological aspects; progestin-releasing intrauterine device; Radiation therapy; Radiotherapy; Skin; Tumors; Uterine cancer; progestin-releasing intrauterine device; palliative radiotherapy; uterine cancer; elderly
• ISSN: 1792-1074; 1792-1082
• DOI: 10.3892/ol.2016.4390

The present study investigated the combination of levonorgestrel-releasing intrauterine device (LNG-IUD) insertion and palliative radiotherapy (RT) as a potential approach for treating frail, elderly endometrial cancer (EC) patients considered unfit for curative oncological treatments. The inclusion criteria were an age of ≥65 years, pathological confirmation of a uterine neoplasm, a Charlson comorbidity index (CCI) value of ≥4 and the presence of vaginal bleeding. Patients underwent intrauterine insertion of an LNG-IUD, and thereafter, received a total dose of 30 Gy at 3 Gy per fraction, over 10 days. The clinical target volume (CTV) was defined as the uterus and disease-involved tissues in the pelvis plus a 1-cm margin. The planning target volume was obtained by adding a 1-cm isotropic margin to the CTV. A total of 9 patients with EC (median age, 85 years; Eastern Cooperative Oncology Group performance status ≥2, ≥88.8%; obesity, 55.5%; median CCI, 5) received an LNG-IUD plus RT. An early complete resolution of bleeding was documented in 8 patients (88.8%), while the remaining patient experienced a marked improvement. The median duration of bleeding control was 18 months, while the 2-year actuarial rate of bleeding-free survival was 53.3% (median follow-up time, 20 months; range, 9-60 months). No LNG-IUD- or severe RT-related complications were documented. Overall, a high rate of bleeding remission, durable bleeding-free survival in face of the easy intrauterine insertion of an LNG-IUD and a negligible toxicity profile of the complete treatment were documented in this study, indicating a requirement for further investigation in a larger series.