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

Macchia,Gabriella; Deodato,Francesco; Cilla,Savino; Legge,Francesco; Carone,Vito; Chiantera,Vito; Valentini,Vincenzo; Morganti,Alessio Giuseppe; Ferrandina,Gabriella

doi:10.3892/ol.2016.4390

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

Authors:
- Gabriella Macchia
- Francesco Deodato
- Savino Cilla
- Francesco Legge
- Vito Carone
- Vito Chiantera
- Vincenzo Valentini
- Alessio Giuseppe Morganti
- Gabriella Ferrandina
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Affiliations: Radiotherapy Unit, Department of Oncology, ‘Giovanni Paolo II’ Foundation, Catholic University of the Sacred Heart, Campobasso I‑86100, Italy, Medical Physics Unit, ‘Giovanni Paolo II’ Foundation, Catholic University of the Sacred Heart, Campobasso I‑86100, Italy, Gynecologic Oncology Unit, Department of Oncology, ‘Giovanni Paolo II’ Foundation, Catholic University of the Sacred Heart, Campobasso I‑86100, Italy, Radiation Oncology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola‑Malpighi Hospital, Bologna I‑40126, Italy, Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Catholic University, I-00168 Rome, Italy
Published online on: March 29, 2016 https://doi.org/10.3892/ol.2016.4390
Pages: 3446-3450

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Abstract

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.

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