5th International Conference on Gynecology and Obstetrics

Evgeniya Sivova has completed her PHD at the age of 33 years from Medical University, RF. She was the vice-chief and gynecologist at the same time at one of the huge hospitals in Krasnoyarsk, and assistant professor of obstetrics and gynecology department of Krasnoyarskii Medical University, RF. She has 41 publications most of them in Russian journals. The topics of scientific interest are endometrial atypical hyperplasia in women of reproductive age and miscarriages.

Background: The increasing incidence of endometrial cancer in women of reproductive age has created a pressing clinical need for uterus-preserving treatment strategies. While hormonal therapy offers a fertility-sparing option, its success heavily depends on baseline tumor characteristics and host endocrine factors. In this context, we sought to evaluate the predictive value of immunohistochemical profiles and hormonal status in achieving oncologic remission and subsequent live births, which remain the ultimate goal for our patients.

Objectives: To test the algorithms of conservative hormonal therapy using buserelin depot and levonorgestrel releasing intrauterine system in women with identified atypical endometrial hyperplasia and/or adenocarcinoma of the uterine body and unrealized fertility.

Methods: The results of the treatment with hormonal drugs were retrospectively evaluated in 52 reproductive-aged patients diagnosed with atypical endometrial hyperplasia ICD-O code 8380/2 (n=40, 77,1% and well-differentiated (grade 1) endometrioid adenocarcinoma of the uterine body ICD-O code 8380/3 (n=12, 22.9%). The expression of immunohistochemical markers, namely ER, PR, Ki-67, Bcl-2, and E-cadherin, was studied in endometrial samples before and after the treatment.

Results: A complete response to the treatment was noted in 100% of cases. The spontaneous pregnancy occurred in 22 cases (40.4%). The recurrence of the disease was not detected in the patients participating in the study for 15 years, the five-year survival rate was 100%. The study of immunohistochemical markers revealed differences in their expression in endometrial samples of the patients with atypical endometrial hyperplasia and endometrioid adenocarcinoma of the uterine body.

Conclusion: The complex use of gonadotropin-releasing hormone agonists (buserelin depot) with the subsequent insertion of levonorgestrel releasing intrauterine device is an effective method of treating atypical endometrial hyperplasia and stage IA well-differentiated endometrioid adenocarcinoma without invasion into the myometrium in reproductive-aged women with unrealized fertility.