Progestin-releasing intrauterine device insertion plus palliative radiotherapy in frail, elderly uterine cancer patients unfit for radical treatment.
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.
Radiotherapy Unit, Department of Oncology, 'Giovanni Paolo II' Foundation, Catholic University of the Sacred Heart, Campobasso I-86100, Italy.
Gabriella
G
Macchia
Radiotherapy Unit, Department of Oncology, 'Giovanni Paolo II' Foundation, Catholic University of the Sacred Heart, Campobasso I-86100, Italy.
Francesco
F
Deodato
Medical Physics Unit, 'Giovanni Paolo II' Foundation, Catholic University of the Sacred Heart, Campobasso I-86100, Italy.
Savino
S
Cilla
Gynecologic Oncology Unit, Department of Oncology, 'Giovanni Paolo II' Foundation, Catholic University of the Sacred Heart, Campobasso I-86100, Italy.
Francesco
F
Legge
Gynecologic Oncology Unit, Department of Oncology, 'Giovanni Paolo II' Foundation, Catholic University of the Sacred Heart, Campobasso I-86100, Italy.
Vito
V
Carone
Gynecologic Oncology Unit, Department of Oncology, 'Giovanni Paolo II' Foundation, Catholic University of the Sacred Heart, Campobasso I-86100, Italy.
Vito
V
Chiantera
Radiotherapy Unit, Department of Oncology, 'Giovanni Paolo II' Foundation, Catholic University of the Sacred Heart, Campobasso I-86100, Italy; Department of Radiotherapy, 'A. Gemelli' Hospital, Catholic University, Rome I-00168, Italy.
Vincenzo
V
Valentini
Radiation Oncology Unit, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S. Orsola-Malpighi Hospital, Bologna I-40126, Italy.
Alessio Giuseppe
AG
Morganti
Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Catholic University, I-00168 Rome, Italy.
Gabriella
G
Ferrandina
elderly; palliative radiotherapy; progestin-releasing intrauterine device; uterine cancer