Harm or benefit of hormonal treatment in metastatic low-grade endometrial stromal sarcoma: Single center experience with 10 cases and review of the literature

Pink, Daniel; Lindner, T.; Mrozek, A.; Kretzschmar, Albrecht; Thuss‐Patience, Peter; Dörken, Bernd; Reichardt, Peter

doi:10.1016/j.ygyno.2005.11.010

Cited by 157 publications

(141 citation statements)

References 46 publications

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“…Especially in young women, menopausal symptoms after surgical castration importantly affect quality of life. Given the detrimental effect of hormone replacement in two small series (Chu et al, 2003;Pink et al, 2006), clinicians are reluctant to prescribe hormonal treatment in women with a history of ESS and symptoms of hormonal depletion. Therefore, the merits of concurrent surgical castration need to be verified.…”

Section: Discussionmentioning

confidence: 99%

Clinical study investigating the role of lymphadenectomy, surgical castration and adjuvant hormonal treatment in endometrial stromal sarcoma

et al. 2007

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The objective of this study is to assess the therapeutic importance of surgical castration, adjuvant hormonal treatment and lymphadenectomy in endometrial stromal sarcoma (ESS). A retrospective and multicentric search was performed. Clinicopathologic data were retrieved from cases that were confirmed to be ESS after central pathology review. The protocol was approved by the Ethical Committee. ESS was confirmed histopathologically in 34 women, but follow-up data were available in only 31 women. Surgical treatment (n ¼ 31) included hysterectomy with or without bilateral salpingo-oophorectomy (BSO) in 23 out of 31 (74%) and 8 out of 31 (26%) cases, respectively. Debulking surgery was performed in 6 out of 31 cases (19%). Stage distribution was as follows: 22 stage I, 4 stage III and 5 stage IV. Women with stage I disease recurred in 4 out of 22 (18%) cases. Among stage I women undergoing hormonal treatment with or without BSO, 3 out of 15 (20%) and 1 out of 7 (14%) relapsed, respectively. Among stages III -IV women receiving adjuvant hormonal treatment or not, 1 out of 5 (20%) and 3 out of 4 (75%) relapsed, respectively (differences ¼ 55.0%, 95% CI ¼ À6.8 -81.2%). Kaplan -Meier curves show comparable recurrence rates for stage I disease without adjuvant hormonal treatment when compared to stages III -IV disease treated with surgery and adjuvant hormonal treatment. Furthermore, women taking hormones at diagnosis have a better outcome when compared to women not taking hormonal treatment. Three out of 31 (9%) patients had a systematic lymphadenectomy whereas 3 out of 31 (9%) had a lymph node sampling. In one case, obvious nodal disease was encountered at presentation. Isolated retroperitoneal recurrence occurred in 1 out of 31 (3%) of all cases and in 1 out of 8 (13%) recurrences. This single woman later also developed lung and abdominal metastases. Leaving lymph nodes in situ does not appear to alter the clinical outcome of ESS. Although numbers are low, the retrospective data suggest that the need for surgical castration (BSO) in premenopausal women with early-stage disease should be discussed with the patient on an individual basis. The data support the current practice in some centres to administer adjuvant hormonal treatment.

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Section: Discussionmentioning

confidence: 99%

Clinical study investigating the role of lymphadenectomy, surgical castration and adjuvant hormonal treatment in endometrial stromal sarcoma

et al. 2007

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“…Data on the efficacy of AIs for ESS are scarce, with most published studies being case reports [23][24][25][26][27][28][29][30]. There is a report of complete responses lasting for more than 7 and 14 years in two patients with lung metastases treated with aminoglutethimide (500 mg bid) [28].…”

Section: Endocrine Therapymentioning

confidence: 99%

“…These include a patient with lung metastases who achieved a complete response lasting for more than 27 months after sequential therapy with letrozole (for 8 months) and anastrozole [23]. In a series of five patients treated with letrozole, durable partial response was obtained in all three cases administered AI as primary treatment and in one treated with MPA [26]. In another series of five patients treated with letrozole for unresectable peritoneal recurrent ESS two patients achieved complete responses lasting for 96 and 87 months [30].…”

Section: Endocrine Therapymentioning

confidence: 99%

Systemic therapy for endometrial stromal sarcomas: current treatment options

Serkies

Pawłowska²,

Jassem³

2016

Ginekol Pol

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Uterine endometrial stromal sarcomas including true low-grade endometrial stromal sarcoma (LG-ESS) and high-grade (HG-ESS) or undifferentiated endometrial sarcoma (UES) constitute a group of rare, aggressive malignancies. Most LG-ESSs express steroid receptors. Surgery is the principal primary therapy for endometrial stromal sarcomas and should be considered in all cases. These malignancies are relatively radio-and chemoresistant. Chemotherapy is used in recurrent and advanced HG-ESS and UES. Currently, the combination of gemcitabine and docetaxel is considered the most effective regimen, but at the expense of substantial toxicity. In steroid receptor positive advanced LG-ESS hormonal therapy, mainly with progestins, allows in some patients for a long-term survival. Aromatase inhibitors seem to be equally effective as first-and subsequent-line of treatment, and are well tolerated. The role of molecular-targeted therapies in endometrial stromal sarcomas remains to be established.

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“…The role of adjuvant therapy, such as radiotherapy, chemotherapy or hormonal treatment, is not fully established (5). While the prognosis of low-grade ESS is favorable, with a 5-year overall survival of >90%, the recurrence-free survival rate is markedly lower at ~50% (6,7).…”

Section: Introductionmentioning

confidence: 99%

“…There are several anecdotal reports of low-grade ESS that responded to aromatase inhibitors, particularly the third generation of these drugs, with more favorable toxicity profiles and thus a wider therapeutic index (6,9). However, due to the rarity of these tumors, there are no prospective or large retrospective studies on aromatase inhibitor use in the treatment of low-grade ESS.…”

Section: Introductionmentioning

confidence: 99%

Long-term treatment of residual or recurrent low-grade endometrial stromal sarcoma with aromatase inhibitors: A report of two cases and a review of the literature

et al. 2015

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Harm or benefit of hormonal treatment in metastatic low-grade endometrial stromal sarcoma: Single center experience with 10 cases and review of the literature

Cited by 157 publications

References 46 publications

Clinical study investigating the role of lymphadenectomy, surgical castration and adjuvant hormonal treatment in endometrial stromal sarcoma

Clinical study investigating the role of lymphadenectomy, surgical castration and adjuvant hormonal treatment in endometrial stromal sarcoma

Systemic therapy for endometrial stromal sarcomas: current treatment options

Long-term treatment of residual or recurrent low-grade endometrial stromal sarcoma with aromatase inhibitors: A report of two cases and a review of the literature

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