PREOPERATIVE OR POSTOPERATIVE MEDICAL-TREATMENT WITH NAFARELIN IN STAGE-III-IV ENDOMETRIOSIS - A FRENCH MULTICENTER STUDY

Objectives: To determine the effectiveness of a 6-month course of nafa relin in the treatment of stage III-IV endometriosis and to determine if pre-operative use of nafarelin facilitates surgery. Design: Prospec tive, multicenter, clinical trial. Setting: Eight university hospitals and two private practice institutions in France. Patients: Fifty-five patients with stage III and IV endometriosis. Two were excluded. Inte rventions: The severity of endometriosis was assessed at the time of l aparoscopy and patients were randomized to have either laparosopic sur gery at that time following 6 months of nafarelin therapy (n = 28), or laparoscopic surgery following 6 months of nafarelin therapy (n = 25) . All had 200 mu g intranasal nafarelin twice a day for 6 months and a second look laparoscopy. Main outcome measure: Clinical efficacy, tol erance to the treatment. Results: Efficacy and tolerance to the treatm ent were the same in both groups. AFS scores compared on both laparosc opies were significantly better if nafarelin was given prior to surger y (P = 0.007). Conclusions: This preliminary study shows that in cases of combined medico-surgical treatment for stage III-IV endometriosis, preoperative medical treatment with GnRH-a gives a better AFS score i mprovement, but no conclusion was possible whether preoperative treatm ent facilitates surgery. (C) 1998 Elsevier Science Ireland Ltd.