Endometriosis: alternative methods of medical treatment.

Endometriosis is an inflammatory estrogen-dependent disease defined by the presence of endometrial glands and stroma at extrauterine sites. The main purpose of endometriosis management is alleviating pain associated to the disease. This can be achieved surgically or medically, although in most women a combination of both treatments is required. Long-term medical treatment is usually needed in most women. Unfortunately, in most cases, pain symptoms recur between 6 months and 12 months once treatment is stopped. The authors conducted a literature search for English original articles, related to new medical treatments of endometriosis in humans, including articles published in PubMed, Medline, and the Cochrane Library. Keywords included "endometriosis" matched with "medical treatment", "new treatment", "GnRH antagonists", "Aromatase inhibitors", "selective progesterone receptor modulators", "anti-TNF α", and "anti-angiogenic factors". Hormonal treatments currently available are effective in the relief of pain associated to endometriosis. Among new hormonal drugs, association to aromatase inhibitors could be effective in the treatment of women who do not respond to conventional therapies. GnRH antagonists are expected to be as effective as GnRH agonists, but with easier administration (oral). There is a need to find effective treatments that do not block the ovarian function. For this purpose, antiangiogenic factors could be important components of endometriosis therapy in the future. Upcoming researches and controlled clinical trials should focus on these drugs.

Natural history of histologically moderate cervical dysplasia in adolescent and young women.

BACKGROUND: Adolescent women are a special age group affected by human papilloma virus (HPV). Most guidelines recommend surgical treatment for high-grade cytological lesions. However, some reports have attempted to demonstrate that the immune system is fully capable of clearing the virus without using conization. Our aim in this study was to describe the outcome of women <25 years old with high-grade cytology pap smears and no histologically confirmed cervical intraepithelial neoplasm [CIN] III. METHODS: This prospective cohort study, carried out at the Department of Obstetrics and Gynecology, Hospital 12 de Octubre, included 29 women aged 25 years or younger with high-grade cytological lesions recruited in screening programs and were followed up at 15 months. This study describes the clinical course of the women, and we determined the percentage of cytological, histological, and microbiological lesions produced by HPV that were cleared without surgical treatment in these women during their follow-up. RESULTS: During follow-up, 63% of high-grade cytological lesions and all high-grade histological lesions were cleared. HPV was eliminated from 23% of patients with one HPV serotype and 27% with multiple HPV serotypes without any treatment. CONCLUSION: These results suggest that there is no need to use surgical treatment to clear high-grade cytological and cervical lesions in adolescent women, thus preventing damage to their reproductive future.

Overall survival and disease-free survival in endometrial cancer: prognostic factors in 276 patients.

OBJECTIVE: The aim of the study reported here was to assess the disease-free survival and overall survival of patients with endometrial cancer and to determine independent factors affecting the prognosis. MATERIALS AND METHODS: This was a retrospective study of a single-center clinical series of 276 patients (mean age 64 years) with histologically confirmed cancer of the corpus uteri. The standard treatments were extrafascial total hysterectomy and bilateral salpingo-oophorectomy with selective pelvic/para-aortic node dissection, according to risk for recurrence. Actuarial overall survival and disease-free survival were estimated according to the Kaplan-Meier method. Univariate and multivariate Cox proportional hazards analyses were used to assess the prognostic significance of the different variables. RESULTS: The estimated median follow-up, determined using the inverse Kaplan-Meier method, was 45 months (95% confidence interval [CI] 41.2-48.8) for disease-free survival and 46 months (95% CI 43.0-49.0) for overall survival. The statistically significant variables affecting disease-free survival and overall survival were age, serous-papillary and clear-cell histological types, outer-half myometrial invasion, advanced International Federation of Gynecology and Obstetrics (FIGO) stage, tumor grades G2 and G3, incomplete surgical resection, positive lymph nodes, lymphovascular space invasion, tumor remnants of >1 cm after surgery, and high-risk group. In the multivariate Cox regression model, predictors of tumor recurrence included advanced FIGO stage (hazard ratio [HR] 4.90, 95% CI 2.57-9.36, P < 0.001) and tumor grades G2 (HR 4.79, 95% CI 1.73-13.27, P = 0.003) and G3 (HR 7.56, 95% CI 2.75-20.73, P < 0.001). The same variables were also associated with a significantly higher risk of tumor-related mortality. CONCLUSION: FIGO stage and tumor grade were independent prognostic factors of disease-free survival and overall survival in endometrial cancer patients. Outcome was also influenced by histopathologic type, myometrial and lymphovascular space invasion, lymph-node involvement, age, and tumor remnants after surgery, although a larger study sample is probably needed to demonstrate the independent association of these variables with survival.