Intrauterine progesterone treatment of early endometrial cancer

OBJECTIVE: Our purpose was to assess the feasibility of using a progesterone-containing intrauterine device (IUD) to treat presumed Federation Internationale Gynecologie et d'Obstetrique (FIGO) stage IA, grade 1 endometrioid cancer in women at high risk for perioperative complications. STUDY DESIGN: Candidates were women with American Society of Anesthesiologists class III or IV grade 1 endometrioid cancer and no imaging evidence of myometrial invasion. Subjects underwent hysteroscopy, curettage, and IUD placement, followed by endometrial biopsy every 3 months for 1 year. The records of similar patients treated surgically during the 3 years before protocol initiation were reviewed for comparison. RESULTS: Sixteen patients fulfilled study criteria. Fourteen consented to participation; one was excluded at the time of IUD placement (grade 2 disease identified) and one was lost to follow-up. Twelve subjects have been followed up to 36 months; results of biopsies were negative in 7 of 11 at 6 months and 6 of 8 at 12 months. No IUD-related complications, except for expulsion, occurred. Sixteen complications (one fatal) occurred in 9 of the 15 control patients. CONCLUSION: Intrauterine progesterone appears to eradicate some cases of presumed stage IA, grade 1 endometrioid cancer in women at high risk for perioperative morbidity.