Faculty of Medicine
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Item type:Publication, Oncologic and pregnancy outcomes of fertility-sparing treatment with medroxyprogesteron acetate in women with premalignant and malignant endometrial lesions: A case series(Elsevier B.V., 2025-04); ; ; ; Introduction Current trends of delaying childbearing and the increasing incidence of endometrial cancer in nulliparous woman necessitate research and development of fertility sparing treatments. Hormonal therapy with progestins offers an alternative to surgical treatment for a select group of patients of reproductive-age, who wish to preserve their reproductive potential. Materials and methods The study evaluates the effectiveness of medroxyprogesterone acetate therapy in patients with early-stage endometrial cancer, atypical endometrial hyperplasia or atypical polypoid adenomyoma, seeking to preserve fertility. This prospective case series encompasses nine patients (6 with endometrial cancer, 2 with atypical endometrial hyperplasia and 1 with atypical polypoid adenomyoma) treated in the period between 2015 and 2022 with high-dose medroxyprogesterone acetate therapy. Treatment and monitoring were conducted at the University Clinic for Gynecology and Obstetrics in Skopje, R. Macedonia, with clinical assessments carried out every three to six months via hysteroscopy with endometrial biopsy or exploratory curettage. Results Primary response was achieved in 4 patients (44.4 %). Secondary response was achieved in the remaining 5 cases (55.6 %). Therefore, all 9 patients (100 %) showed complete response to progestin treatment in the time interval 3–9 months. Recurrence occurred in 3 cases (33.3 %) after follow-up of 15, 33 and 84 months, respectively. During the study period, 2 patients (22.2 %) underwent definitive surgery with hysterectomy because of disease recurrence (both with endometrial cancer, stage IA). Fertility was achieved in 1 patient (11.1 %), who had a full-term delivery with caesarean section. Conclusion Conservative treatment approach to patients with endometrial cancer aiming to preserve fertility can be safe and have acceptable outcomes in terms of oncologic response as well as pregnancy results, with high-dose medroxyprogesterone acetate therapy being an effective option. The selection of endometrial cancer patients, for whom fertility-sparing progestin therapy is appropriate, is of great importance to achieve the best outcomes. Continuous and careful monitoring of patients undergoing conservative treatment is essential, due to the risk of disease recurrence and progression. - Some of the metrics are blocked by yourconsent settings
Item type:Publication, OBJECTIVE METHODS FOR ASSESSMENT OF DEEP MYOMETRIAL AND CERVICAL INVASION IN PATIENTS WITH ENDOMETRIAL CANCER(SHMSHM - AAMD, 2023-12); ; ; Introduction: Endometrial cancer is the most common gynaecological malignancy. This study analyzed different objective methods with transvaginal ultrasonography for the assessment of deep myometrial and cervical invasion in patients with endometrial cancer to choose the optimal surgical treatment. Material and methods: It represents a prospective cohort study in which 45 patients with a histological diagnosis of endometrial cancer were analyzed. They are examined with transvaginal ultrasound to assess deep myometrial and cervical invasion. Results: Objective parameters such as those of Gordon result in a sensitivity of 76% and a specificity of 85% and Carlson with a sensitivity of 72% and specificity 95%. 3D ultrasonography resulted in a sensitivity of 92% and a specificity of 78%. The objective assessment of cervical tumour invasion below the OUI (internal uterine orificum) had a sensitivity of 70% and a specificity of 85%, and the one with a cut-off <20.5mm distance from the OUE (external uterine orificium) to the lower margin of the tumour had a sensitivity of 86% and specificity 75%. Discussion: The therapeutic modality in patients with endometrial cancer depends on several factors such as histological type, nuclear grade, myometrial and cervical invasion, which, if present, require radical surgical treatment and the need for evaluation of lymph nodes for appropriate surgical staging. Conclusion: The obtained results are comparable with relevant works on this issue. Transvaginal ultrasonography is similarly effective to nuclear magnetic resonance for assessing deep myometrial and cervical invasion.