Treatment of Endometrial Stromal Sarcoma With a Gonadotropin-Releasing Hormone Analogue

Burke, Cathy; Hickey, Kevin

doi:10.1097/01.aog.0000133533.05148.aa

Cited by 54 publications

(25 citation statements)

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“…We perform secondary and tertiary debulking surgery with organ resection and thoracotomies to tackle recurrent disease. Progestins (Gloor et al, 1982), gonadotropin-releasing agonists (Burke and Hickey, 2004) and aromatase inhibitors (Maluf et al, 2001;Leunen et al, 2004) are prescribed as systemic treatment in between the surgeries.…”

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.…”

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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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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 options of adjuvant therapy following surgery include radiotherapy, chemotherapy, hormonal therapy and observation. [12][13][14] The indications and the roles of adjuvant therapies remain controversial. Low grade ESSs are mostly steroid receptor-positive tumors, which means hormonal therapy with progestins, aromatase inhibitors (third generation) and gonadotropin-releasing hormone (GnRH) analogues is effective.…”

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A case of multiple metastatic low-grade endometrial stromal sarcoma arising from an ovarian endometriotic lesion

et al. 2009

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“…5 Studies have shown successful reduction of stage I sarcomas with treatment. 23 All of these studies provide positive data to support the use of hormonal therapy for the treatment and prevention of recurrences. Although there are no guidelines developed for the optimal drug, dose and time-frame for usage, it may be reasonable to use hormone therapy for all surgically resected receptor-positive LGESS, as commonly applied in breast carcinoma.…”

Section: Hormonal Therapymentioning

confidence: 95%

Hormonal Treatment of Metastatic Endometrial Stromal Sarcomas

Kitayama¹,

Shimizu²,

Terada³

2011

European Oncology &Amp; Haematology

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Uterine sarcomas in general are rare: they account for 4% of all uterine malignancies. [1][2][3][4] Endometrial sarcomas account for 10-15% of all uterine sarcomas. They make up fewer than 1% of all gynaecological malignancies. 1,2,5,6 The reported incidence is approximately one to two cases per million women in the US. 6,7 Women often present with an enlarged uterus or have complaints of heavy menstrual bleeding.Occasionally, the diagnosis is established by endometrial biopsy or diagnostic curettage. Most often, however, the diagnosis is not recognised until the time of hysterectomy. Generally, these women are pre-or peri-menopausal at the time of diagnosis. AbstractEndometrial sarcomas account for 10-15% of all uterine sarcomas. These tumours are composed of uniform cells that resemble the stromal cells of proliferative endometrium. As endometrial sarcomas are rare, accounting for less than 1% of all gynaecological malignancies, there is an absence of clinical trials and treatment guidelines do not exist. It is well-known that low-grade endometrial stromal sarcomas (LGESS) are often oestrogen-receptor-(OR) and progesterone-receptor-(PR) positive. This provides a potential target for treatment, similar to other hormonally sensitive tumours. This article reviews the literature in terms of current management strategies for LGESS, particularly the data in terms of hormonal therapy. KeywordsEndometrial stromal sarcoma, uterine sarcoma, mesenchymal tumours, hormone therapy, progestins

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Treatment of Endometrial Stromal Sarcoma With a Gonadotropin-Releasing Hormone Analogue

Abstract: Control of progression of a recurrent endometrial stromal sarcoma was achieved with the GnRH analogue triptorelin. This is the first report in the English-language literature during a 30-year period of single-agent GnRH analogue being an effective treatment intervention in this context.

Cited by 54 publications

References 5 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

A case of multiple metastatic low-grade endometrial stromal sarcoma arising from an ovarian endometriotic lesion

Hormonal Treatment of Metastatic Endometrial Stromal Sarcomas

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