Treatment of endometrial stromal tumors

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Low-grade endometrial stromal sarcoma: a single center's experience with 22 cases

Kim

Lee

Choi

et al. 2008

“…However, higher recurrence rates have been reported in patients with preserved ovaries. 3,14 Although only one of our patients had retained ovaries, she eventually developed a recurrence in the retained adnexa. These results are consistent with the known high rate of estrogen and progesterone receptor expression in these tumors.…”

Section: Discussionmentioning

confidence: 81%

Endometrial Stromal Sarcoma: Treatment and Patterns of Recurrence

Thomas¹,

Keeney

Podratz³

et al. 2009

Our objective was to investigate recurrence patterns and conduct an outcome analysis of patients with endometrial stromal sarcoma (ESS).A retrospective review yielded 30 patients with ESS (20 low-grade, 10 high-grade) who underwent primary surgical resection from 1982 to 2005. Median follow-up was 42 months.All patients underwent hysterectomy, whereas pelvic (P) and paraaortic (PA) lymphadenectomy were performed in 12 and 7 patients, respectively. A median of 26 pelvic lymph nodes and 9 PA lymph nodes were removed. Pelvic or PA lymphatic disease was noted in 25% and 29% of patients, respectively. Extrauterine disease was identified in 11 (45%) of 24 patients undergoing exploratory laparotomy; 6 had no residual disease after cytoreductive surgery. None of these 6 patients experienced abdominal failure, but 1 had a hematological recurrence. Thrombotic complications were noted in 13% of patients. The 5-year overall survival was 65%. Overall survival was influenced by grade (79% vs 40%, P = 0.03) and extrauterine disease (77% vs 32%, P = 0.01). No patient who underwent a systematic lymphadenectomy had a lymphatic recurrence, irrespective of nodal status. There were 7 (23%) hematological recurrences; 2 in surgical stage I ESS. Two patients with low-grade ESS remain without evidence of disease 130 and 210 months after secondary cytoreduction. In contrast, no patient with high-grade ESS survived a recurrence.There is high prevalence of extrauterine and nodal disease in ESS. Patients are at high risk for thrombotic complications. If aggressively staged, the predominant failure risk for stage I patients is hematogenous, suggesting the need for improved systemic treatments.

Conservative management of endometrial stromalsarcoma in young women

Lissoni¹,

Cormio²,

Perego³

et al. 1997

Lissoni A, Cormio G, Perego P, Gabriele A, Cantú MG, Bratina G. Conservative management of endometrial stromal sarcoma in young women. Int J Gynecol Cancer 1997; 7: 364-367. Endometrial stromal sarcoma (ESS) is a rare malignancy with an associated poor prognosis. Total abdominal hysterectomy is considered the treatment of choice, and the role of conservative, fertility-sparing surgery in young patients desiring pregnancy is not well-defined. Six patients were managed conservatively for ESS between 1982 and 1996 at our institution. The sources of tissue for diagnosis were polyps or myomas removed for relief of symptoms. Median age of the patients was 27 years (range 18-36), and all were nulliparous. One patient had a highgrade ESS (12 mitoses per 10 HPF) with extensive necrosis and atypia. The remaining five patients had a low-grade ESS, with a median mitotic count of 4 per 10 HPF (range 2-6). In all cases the tumor was completely resected, with a safe resection margin of at least 2 mm. No patients received adjuvant treatment. At a median follow-up of 51 months (range 12-84) all patients are alive and well without recurrence. Two patients (33%) had a spontaneous delivery at term, whereas one patient had a miscarriage at the 8th week of gestation. Conservative management of endometrial stromal sarcoma may be attempted in selected patients desiring pregnancy. Adequate follow-up is mandatory in order to detect recurrence as soon as possible. Considering the indolent growth of low-grade ESS, definitive surgery can be postponed until after completion of the reproductive function.