Low-grade endometrial stromal sarcoma: hormonal aspects☆

Chu, Micheline C.; Mor, Gil; Lim, Chungyun; Zheng, Wenxin; Parkash, Vinita; Schwartz, Peter E.

doi:10.1016/s0090-8258(03)00258-0

Cited by 208 publications

(166 citation statements)

References 27 publications

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“…Given the considerable recurrence rates, these results suggest adjuvant hormonal treatment to be beneficial in early-and advanced-stage ESS. This hypothesis is in line with the observation that 6 out of 8 (75%) and 2 out of 7 (29%) recurrences were noted in early-stage women with and without adjuvant hormonal treatment, respectively (Chu et al, 2003). Given the paucity of retrospective data and the difficulties in organising prospective trials in ESS, the importance of adjuvant hormonal intake is clinically relevant.…”

Section: Discussionsupporting

confidence: 75%

“…Comparing 12 premenopausal women with ESS who did not undergo BSO with 24 matched controls, Li et al (2005) observed similar progression-free survival and overall survival in their series. Also Gadducci et al (1996) and Chu et al (2003) observed comparable recurrence rates in women with and without BSO. Thus, since current studies cannot demonstrate a benefit for women undergoing hormonal castration for a hormone-sensitive disease and given the side effects of hormonal castration, it appears advisable to leave the ovaries in situ when ESS is diagnosed.…”

Section: Discussionmentioning

confidence: 63%

“…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%

“…Daily dosages of 160 mg megestrolacetate (Chu et al, 2003) or 250 mg medroxyprogesteroneacetate are considered high dose, whereas physiologic effects of both drugs are already obtained with 5 mg dosages.…”

Section: Discussionmentioning

confidence: 99%

“…Endometrial stromal sarcoma development and/or recurrences can be induced by oestrogen-replacement therapy and tamoxifen (Beer et al, 1995;Chu et al, 2003), whereas progestins (Gloor et al, 1982), gonadotropin-releasing hormone analogues (Burke and Hickey, 2004) and aromatase inhibitors inhibit tumour growth (Maluf et al, 2001;Leunen et al, 2004). Recurrence rates in early-stage ESS are high (Chang et al, 1990), and the impact of surgical castration and adjuvant hormonal treatment needs to be investigated further.…”

mentioning

confidence: 99%

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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: Discussionsupporting

confidence: 75%

Section: Discussionmentioning

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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

et al. 2007

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Endometrial Stromal Sarcomas

Schmeler

Rauh‐Hain²,

Carmen

2014

Uncommon Gynecologic Cancers

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Hormonal therapy in uterine sarcomas

et al. 2019

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Uterine sarcomas (USs) are a group of rare but aggressive uterine malignancies, accounting for only 1% of the malignant tumors of female reproductive organs. Due to the high rate of recurrence and metastasis, the prognosis of USs is poor. Given the high mortality rate and limited clinical benefit of surgery and adjuvant chemoradiotherapy, hormonal therapy has shown good prospects in recent years. Hormonal agents include progestins, aromatase inhibitors (AIs), and gonadotropin‐releasing hormone analogue (GnRH‐a). According to the literature, hormonal therapy has been confirmed effective for recurrent, metastatic or unresectable low‐grade endometrial stromal sarcoma (LGESS) and hormone receptor positive (ER+/PR+) uterine leiomyosarcoma (uLMS) with favorable tolerance and compliance. Besides, hormonal therapy can also be used in patients with early‐staged disease who desire to preserve fertility. However, due to the rarity of USs, the rationale of hormonal therapy is generally extrapolated from data of hormone‐sensitive breast cancer, and present studies of hormonal therapy in USs were almost limited to case reports and small‐sized retrospective studies. Therefore, further systematic researches and standardized clinical trials are needed to establish the optimal hormonal therapy regimen of USs. Herein, we reviewed the existing studies related to the hormonal therapy in USs in order to provide reference for clinical management in specific settings.

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Low-grade endometrial stromal sarcoma: hormonal aspects☆

Cited by 208 publications

References 27 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

Endometrial Stromal Sarcomas

Hormonal therapy in uterine sarcomas

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