Laparoscopic intraperitoneal injection of human interferon-α2b in the treatment of pelvic endometriosis: a new modality

Background: Some reports have stated that an immunologic alteration plays a role in the development and progression of endometriosis. Once endometrial cells are implanted ectopically, they may produce additional changes through a defect in cellular or humoral immunity. Natural killer cell, cytokines, and peritoneal macrophages could determine the role of progression of the disease. Therapeutic manipulation of the immune system in patients with endometriosis may be worth mention. Braum et al (1992) suggested that macrophage activators such as interferons (IFNs) could be useful in addition to hormone suppression therapy, to control and eliminate the growth of endometrial ectopic tissue. Objective: To use for the first time laparoscopic intraperitonal injection of human IFN-α2b in the treatment of pelvic endometriosis. Methods: Twenty-five infertile women were enrolled in the study. They had pelvic endometriosis. The diagnosis was based on laparoscopy, and CA 125 was measured in all cases. They were classified as the following: Stage II—mild endometriosis (5 cases), Stage III—moderate endometriosis (10 cases), and Stage IV—severe endometriosis. We proposed a protocol of dosage system. For Stage I—we used 3 million IU of IFN-α2b, for Stage II—6 million units, for Stage IV—12 million IU. We directly injected the dosage through laparoscopy. Objective measurement for evaluating the implant growth depends on the measurement of the largest diameter and change of the degree of the stage of endometriosis. Second-look laparoscopy was done 3 months later in all patients and CA 125 measurement was also done. All the patients were evaluated clinically for dyspareunia, painful defecation, and progressive dysmenorrhea. Vaginal examination was done for cul-de-sac induration, fixed ovarian masses, and uterosacral ligament nodularity. Results: There was a statistically significant (P <0.05) decrease in all symptoms and signs after treatment; the decrease was proportional to the size and diameter of large implant and the degree of endometriosis. There was a statistically significant decrease in the level of CA 125 after treatment (P <0.001). On laparoscopy, there was diminution of the stage of disease. Grade II changed to grade I, grade III changed to grade II, and grade IV changed to grade III. Complete disappearance of disease was noted in 2 cases in grade II (20%) and in 2 cases in grade III (10%). In grade IV, there was no reported case of complete disappearance of endometriosis. Cumulative pregnancy rate in all three stages after treatment was 33.3%. No reported side effects of treatment were noted. Conclusions: Human IFN-α2b immune stimulatory therapy significantly reduces the symptoms of endometriosis. Reduce the stage of the disease, reduce CA 125 level, reduce the size of implant, and improve the pregnancy rate, so we can say that this line is a break treatment in the field of endometriosis. More studies are needed; closed, double-blind, controlled, randomized studies are needed for better evaluation of the results of treatment.