title: Is levonorgestrel intrauterine system effective for treatment of early endometrial cancer? Report of four cases and review of the literature.
abstract: BACKGROUND
  Intrauterine progesterone therapy potentially provides a simple alternative treatment for women with Stage I Grade I endometrial cancers who are at high risk for surgery. The case histories of four women with early endometrial cancer primarily treated with levonorgestrel intrauterine system (Mirena) are reported and the literature reviewed.
  
  
  METHODS
  Four women had Stage I grade 1 endometrial adenocarcinoma with positive progesterone receptor. All were assessed to be in American Society of anaesthesiologists risk class IV. After insertion of mirena intrauterine system, one woman (25%) had complete histological regression of disease within 6 months. One of three women who did not respond to treatment subsequently had a vaginal hysterectomy, which showed endometrial cancer with superficial myometrial invasion.
  
  
  CONCLUSIONS
  This report raises doubts about the effectiveness of intrauterine progesterone therapy as a definitive alternative for the treatment of early endometrial cancer.
authors.affiliation: Department of Gynaecology, St Mary's Hospital, Portsmouth PO3 6AD, UK.
authors.forename: Kalyan K
authors.initials: KK
authors.lastname: Dhar
authors.forename: T
authors.initials: T
authors.lastname: NeedhiRajan
authors.forename: M
authors.initials: M
authors.lastname: Koslowski
authors.forename: Robert P
authors.initials: RP
authors.lastname: Woolas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018931:Antineoplastic Agents, Hormonal / Q000008:administration & dosage*; D018269:Carcinoma, Endometrioid / Q000188:drug therapy*; D004333:Drug Administration Routes; D016889:Endometrial Neoplasms / Q000188:drug therapy*; D005260:Female; D006801:Humans; D016912:Levonorgestrel / Q000008:administration & dosage*; D008875:Middle Aged; D014599:Uterus
chemical_list: D018931:Antineoplastic Agents, Hormonal; D016912:Levonorgestrel