goserelin and Endometrial-Neoplasms

Low-grade endometrial stromal sarcomas are steroid receptor positive tumors with slow tumor progression and high recurrence rates, which lack established treatment protocols. We present an update on hormonal therapy options.. In the past, hormonal therapy consisted of progestins for advanced/recurrent/metastatic low-grade endometrial stromal sarcomas. Aromatase inhibitors and gonadotropin-releasing hormone analogues have become new effective alternatives for first and second line treatment. The high recurrence rates after short disease free intervals in low-grade endometrial stromal sarcoma patients were partly due to inadvertent growth stimulation during estrogen-containing hormone replacement therapy and tamoxifen treatment, which - according to current knowledge - are contraindicated. Recently, hormonal therapy has been introduced for the prevention of recurrences. Aromatase inhibitors are becoming the treatment of choice, since progestins are poorly tolerated due to side effects. The effective duration of preventive hormonal therapy is still undetermined.. Hormonal therapy with progestins, aromatase inhibitors and gonadotropin-releasing hormone analogues has become an effective treatment alternative to radiation and chemotherapy for low-grade endometrial stromal sarcoma patients. Preventive hormonal therapy is of particular interest in the setting of concomitant endometriosis.

Topics: Antineoplastic Agents, Hormonal; Aromatase Inhibitors; Endometrial Neoplasms; Female; Gonadotropin-Releasing Hormone; Goserelin; Humans; Neoplasm Recurrence, Local; Sarcoma, Endometrial Stromal

The results of conservative treatment of 121 patients with endometrial atypical hyperplasia (EAH) and early endometrial cancer (EC) with preservation of fertility are presented. In EAH (n = 56) for 6 months the intrauterine spiral Mirena was used. The effectiveness was 91%, the recurrence rate 16%, pregnancies occurred in 16% of patients. In EC (n = 65) hormone therapy was conducted for 6 months using the intrauterine spiral Mirena and zoladex. The effectiveness was 79%, recurrence rate 22%, pregnancies occurred in 24% of patients. Based on our data and on the results of other studies, the benefits and risks of hormone therapy alone for EAH and EC are discussed in women of reproductive age.

Topics: Adult; Antineoplastic Agents, Hormonal; Drug Administration Schedule; Endometrial Hyperplasia; Endometrial Neoplasms; Female; Goserelin; Humans; Levonorgestrel; Neoplasm Recurrence, Local; Precancerous Conditions; Pregnancy; Pregnancy Complications, Neoplastic; Pregnancy Rate; Treatment Outcome

To evaluate the benefits of systematic preoperative treatment with LH-RH agonists prior to endometrial resection (ER).. The study population was made up of 98 premenopausal women who underwent resectoscopic treatment for abnormal uterine bleeding (AUB) between January 1996 and December 1997. Only patients with endometrial polyps or dysfunctional bleeding were included. The population was divided into two groups: patients who had (group B) and those who had not (group A) received LH-RH before the surgical intervention.. ER was carried out as a single procedure in 66 (67.5%) of the patients. ER plus polypectomy was necessary in 32 (32.5%) patients. There were no differences between the two groups as far as the operating time and total volume of distension medium were concerned. No intraoperative complications were seen in either group. A higher negative balance of distension medium was achieved in group A (320 +/- 23 mL versus 187 +/- 16 mL; P < 0.001), and this difference was not modified when cases with polyps were excluded. The failure rate was similar in both groups both at 12 months [group A 6 (14.8%) versus group B 7 (14.9%) patients] and at 60 months [group A, 11 (21.6%) versus group B 10 (21.2%) patients]. Likewise, the amenorrhea and hypomenorrhea rates at 12 months and at 60 months were also shown to be the same in both groups. When two doses of LH-RH are used and the failure rate is taken into account the cost of an acceptable outcome increases from 843.37 Euro to 1373.49 Euro per patient, while the total cost of a hysterectomy is 1355.42 Euro.. Endometrial suppression with LH-RH agonists did not guarantee better results of ER, but they are strongly recommended during the learning curve to achieve a safer procedure.

Topics: Adult; Endometrial Neoplasms; Endometrium; Female; Gonadotropin-Releasing Hormone; Goserelin; Gynecologic Surgical Procedures; Hormones; Humans; Middle Aged; Polyps; Preoperative Care; Prospective Studies; Treatment Outcome; Uterine Hemorrhage

This Gynecologic Oncology Group (GOG) study was designed to estimate the activity of goserelin acetate as treatment for advanced and recurrent endometrial carcinoma. Forty evaluable patients received monthly treatment with goserelin acetate at a dose of 3.6 mg, given subcutaneously. Standard GOG response and adverse effects criteria were used. The median age of patients was 71 years. Seventy-one percent of patients had received prior radiation therapy; 18% of patients were reported to have received prior progestational therapy for endometrial cancer. One patient had received prior chemotherapy. There were two complete responses (5%) and three partial responses (7%). One response occurred in a patient who previously did not respond to progestin therapy after having achieved a response. The overall response rate was 11% (95% CI: 4-27%). Median progression-free survival was 1.9 months and median overall survival was 7.3 months. No severe or life-threatening toxicities occurred because of goserelin. Deep venous thrombosis developed in two patients. This study confirmed the limited activity of goserelin acetate in endometrial carcinoma, with only one response in a patient previously treated with hormonal therapy. The activity is insufficient to warrant further study of the single agent at this time. Elucidation of the mechanism of action of this drug may allow more effective use in conjunction with other agents in the future.

Topics: Aged; Aged, 80 and over; Antineoplastic Agents, Hormonal; Endometrial Neoplasms; Female; Goserelin; Humans; Middle Aged; Neoplasm Metastasis; Neoplasm Recurrence, Local; Neoplasm Staging; Survival Analysis

Our aim was to summarize our and foreign experience in the field of diagnosis, progression and modern treatment of precancer of the endometrium-the atypical glandular hyperplasia.. We researched 750 cases with glandular and atypical glandular hyperplasia for 10 years period (2000-2010). The hyperplasia were followed up for progression from glandular hyperplasia into atypical glandular hyperplasia and early endometrial cancer. The hyperplasias were evaluated with or without progestagen hormonal therapy. All patients were treated by D&C before and after the hormonal treatment.. The main symptom in all patients was the postmenopausal bleeding (72% from the cases). In 90% of the patients (675) there was obesity. Exogenous use of estrogens was found in 30% (225) of the patients. The cases with complex hyperplasia in 12% (65/525) progressed into atypical glandular hyperplasia and in 4% (21/525) progressed into endometrial cancer. The patients with atypical glandular hyperplasia in 60% (90/150) progressed into endometrial cancer. Remission was observed in 70% of the patients (194/278) with glandular hyperplasia and progestagen treatment. The remission was detected by the golden standart (D&C). The patients without hormonal treatment and with complex glandular hyperplasia have in 15% (37/247) remission. Except with progestagen therapy, we have also 15 patients treated with GnRh-analogs (Zoladex a 3.6 mg) for 3-6 months. For them we have 80% (12/15) remission.. The glandular hyperplasia without atypical cells can be influenced by the hormonal treatment with progestagens and GnRh-analogs. Nevertheless this hormonal treatment--before and after we have to perform D&C and to follow up patients by ultrasound measuring the endometrial thickness. If the fertility plans of the patients are over and if they are in postmenopause with histological result from D&C-atypical glandular hyperplasia--we have to treat them more radically with simple total hysterectomy.

Topics: Antineoplastic Agents, Hormonal; Disease Progression; Endometrial Hyperplasia; Endometrial Neoplasms; Female; Follow-Up Studies; Gonadotropin-Releasing Hormone; Goserelin; Humans; Progestins

Approximately 50% of patients with low-grade endometrial stromal sarcoma (ESS) develop recurrent disease including mainly metastases of pelvis and lung. A solitary pulmonary metastasis of this disease is a rare phenomenon.. After initial surgical treatment in 1990, a 28-year-old female developed solitary metastases of the lung in 1998 and 1999, which were surgically removed both times. The patient was then treated with goserelin for 2 years followed by anastrozole to date. She has since been disease-free.. This case report emphasizes the importance of long-term follow-up and initial surgical treatment of low-grade ESS and suggests systemic hormonal therapy in case of recurrence.

Topics: Adult; Anastrozole; Antineoplastic Agents, Hormonal; Combined Modality Therapy; Disease-Free Survival; Endometrial Neoplasms; Female; Goserelin; Humans; Lung Neoplasms; Neoplasm Recurrence, Local; Nitriles; Sarcoma, Endometrial Stromal; Triazoles

Low-grade endometrial stromal sarcoma is an uncommon, indolent uterine sarcoma that can arise in extrauterine locations. The objective of this study was to report on a previously unpublished site of origin for a low-grade endometrial stromal sarcoma.. A case of a low-grade endometrial stromal sarcoma arising in the ectocervix after goserelin hormonal therapy for breast cancer was studied.. Low-grade endometrial stromal sarcoma can arise in the ectocervix even in the absence of endometriosis.. Low-grade endometrial stromal sarcoma should be included in the differential diagnosis of sarcomas of the ectocervix.

Topics: Antineoplastic Agents, Hormonal; Breast Neoplasms; Endometrial Neoplasms; Female; Goserelin; Humans; Middle Aged; Neoplasms, Second Primary; Sarcoma, Endometrial Stromal; Uterine Cervical Neoplasms

Topics: Adult; Antineoplastic Agents, Hormonal; Diagnosis, Differential; Endometrial Neoplasms; Female; Gonadotropin-Releasing Hormone; Goserelin; Humans; Leiomyoma; Uterine Neoplasms

A 30-year old female who initially had typical endometriosis treated according to a standard regimen later developed numerous highly vascular endometrial polyps on the vagina, cervix, ureter, serosal surfaces of the uterus, pouch of Douglas (POD) and other areas of pelvic peritoneum as well as the endometrium 8 months after withdrawal of treatment with Zoladex gonadotrophin releasing hormone (GnRH) agonist used for treatment of this disease. We postulate that these polyps developed as a rebound phenomenon upon withdrawal of Zoladex. We believe this is the first report of this complication following use of GnRH analogue.

Topics: Adult; Antineoplastic Agents, Hormonal; Endometrial Neoplasms; Endometriosis; Female; Gonadotropin-Releasing Hormone; Goserelin; Humans; Polyps; Substance Withdrawal Syndrome

Twenty-one patients were enrolled in a pilot study in order to evaluate the clinical efficacy of the GnRH analogues in the treatment of hormone dependent gynaecological malignancies. Seven patients with recurrent or advanced endometrial adenocarcinoma and fourteen patients with ovarian carcinoma had a 4-weekly subcutaneous injection in the abdominal wall of 3.6 mg goserelin (Zoladex--ICI Pharmaceuticals). Overall, four of the 21 patients showed regression, nine had their disease stabilised and eight showed progression. No important side effects were noticed.

Topics: Endometrial Neoplasms; Female; Goserelin; Humans; Neoplasm Recurrence, Local; Ovarian Neoplasms; Pilot Projects