Clinical outcomes of uterine sarcomas: results from 14 years worth of experience in the Kinki district in Japan (1990–2003)

2006 ◽  
Vol 16 (3) ◽  
pp. 1358-1363
Author(s):  
K. Kokawa ◽  
K. Nishiyama ◽  
M. Ikeuchi ◽  
Y. Ihara ◽  
N. Akamatsu ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Early Stage ◽  
Disease Free Survival ◽  
Stage Iv ◽  
Endometrial Stromal Sarcoma ◽  
Uterine Sarcomas ◽  
Stromal Sarcoma ◽  
Younger Age ◽  
Histologic Types ◽  
Disease Free

To review clinical outcomes and therapeutic varieties, we were invited to submit data from the patients who were treated for uterine sarcomas in Japan from 1990 to 2003. Uterine sarcomas were defined as leiomyosarcoma (LMS), endometrial stromal sarcoma (ESS), and carcinosarcoma (CS). Of a total of 97 patients, 36 (37.1%) were diagnosed with LMS of the uterine corpus, 15 (15.5%) with ESS, 46 (47.4%) with CS. Median age at diagnosis was 59 (21–85) years. Clinical stages based on FIGO were 41 (42.3%) with stage I disease, 6 (6.2%) with staged II, 34 (35.1%) with stage III, and 16 (16.5%) with stage IV. The median follow-up period for all patients was 13 (1–108) months and median disease-free period was 9 (0–96) months. The 1-year survival rate and disease-free survival (DFS) rate were calculated in patients with all sarcomas (overall survival [OAS], 61.3%; DFS, 46.6%). Statistical analysis showed that younger age (less than 50 years), early stage (stages I and II), and surgical procedure (extended hysterectomy [EH] and radical hysterectomy [RH]) were associated with significantly better OAS. Histologic types did not affect the survival period. In conclusion, aggressive surgery including EH or RH at the time of initial operation offers the possibility of prolonged survival.

Localized high grade endometrial stromal sarcoma and localized undifferentiated uterine sarcoma: a retrospective series of the French Sarcoma Group

2019 ◽  
Vol 29 (4) ◽  
pp. 691-698 ◽  
Author(s):  
Marie Meurer ◽  
A Floquet ◽  
I Ray-Coquard ◽  
F Bertucci ◽  
M Auriche ◽  
...  
Keyword(s):  
Overall Survival ◽  
Adjuvant Chemotherapy ◽  
Adjuvant Radiotherapy ◽  
Disease Free Survival ◽  
Endometrial Stromal Sarcoma ◽  
High Grade ◽  
Uterine Sarcomas ◽  
Free Survival ◽  
Stromal Sarcoma ◽  
Disease Free

ObjectiveHigh grade endometrial stromal sarcoma and undifferentiated uterine sarcomas are associated with a very poor prognosis. Although large surgical resection is the standard of care, the optimal adjuvant strategy remains unclear.MethodsA retrospective analysis of patients with localized high grade endometrial stromal sarcoma and undifferentiated uterine sarcomas (stages I–III) treated in 10 French Sarcoma Group centers was conducted.Results39 patients with localized high grade endometrial stromal sarcoma and undifferentiated uterine sarcomas treated from 2008 to 2016 were included. 24/39 patients (61.5%) were stage I at diagnosis. 38/39 patients underwent surgical resection, with total hysterectomy and bilateral oophorectomy completed in 26/38 (68%). Surgeries were mostly resection complete (R0, 23/38, 60%) and microscopically incomplete resection (R1, 6/38, 16%). 22 patients (58%) underwent postoperative radiotherapy (including brachytherapy in 11 cases), and 11 (29%) underwent adjuvant chemotherapy. After a median follow-up of 33 months (range 2.6–112), 17/39 patients were alive and 21/39 (54%) had relapsed (9 local relapses and 16 metastases). The 3 year and 5 year overall survival rates were 49.8% and 31.1%, respectively, and 3 year and 5 year disease free survival rates were 42.7% and 16.0%, respectively. Median overall survival and disease free survival were 32.7 (95% CI 16.3–49.1) and 23 (4.4–41.6) months, respectively. Medians were, respectively, 46.7 months and 39.0 months among those who underwent adjuvant radiotherapy and 41.0 months and 10.3 months for those who underwent adjuvant chemotherapy. In multivariate analysis, adjuvant radiotherapy was an independent prognostic factor for overall survival (P=0.012) and disease free survival (P=0.036). Chemotherapy, International Federation of Gynecology and Obstetrics I–II stages, and Eastern Cooperative Oncology Group-performance status 0 correlated with improved overall survival (P=0.034, P=0.002, P=0.006), and absence of vascular invasion (P=0.014) was associated with better disease free survival.ConclusionsThe standard treatment of primary localized high grade endometrial stromal sarcoma and undifferentiated uterine sarcomas is total hysterectomy and bilateral oophorectomy. The current study shows that adjuvant radiotherapy and adjuvant chemotherapy appear to improve overall survival. A prospective large study is warranted to validate this therapeutic management.

Cytoreduction as a remedial procedure improves disease-free survival of patients with occult uterine sarcoma undergoing morcellation——a retrospective study

2020 ◽  
Author(s):  
Chao Ding ◽  
Jianqing Zhu
Keyword(s):  
Disease Free Survival ◽  
Endometrial Stromal Sarcoma ◽  
Uterine Sarcoma ◽  
Uterine Leiomyosarcoma ◽  
Uterine Sarcomas ◽  
Free Survival ◽  
Total Hysterectomy ◽  
Stromal Sarcoma ◽  
Significant Difference ◽  
Disease Free

Abstract Background：Tumor morcellation happened to facilitate iatrogenic metastasis for patients with occult uterine sarcoma. The optimal remedial procedure for these patients needed to be established. Methods：Data were retrospectively collected and analyzed from patients with occult uterine sarcoma undergoing morcellation. Results：23 consecutive patients with uterine sarcomas undergoing morcellation were accessed between Jan 2008 and Dec 2018, including 15 patients with uterine leiomyosarcoma and 8 with endometrial stromal sarcoma. Cytoreduction as a remedial procedure was significantly associated with better disease-free survival (P=0.031), and none of 7 patients undergoing cytoreduction suffered recurrence, while total hysterectomy (P=0.194) and adjuvant therapy (P=0.159) had no such benefit. There was no significant difference in disease-free survival between laparoscopic and open surgery (p=0.321). Conclusion：Cytoreduction was considered as the optimal remedial procedure for patients with occult uterine sarcoma undergoing morcellation.

scholarly journals Omentectomy in Combination With Hysterectomy As a Remedial Procedure Improves Disease-Free Survival of Patients With Occult Uterine Sarcoma Undergoing Morcellation: A Retrospective Study

2021 ◽  
Author(s):  
Chao Ding ◽  
Jianqing Zhu
Keyword(s):  
Open Surgery ◽  
Disease Free Survival ◽  
Endometrial Stromal Sarcoma ◽  
Uterine Sarcoma ◽  
Uterine Leiomyosarcoma ◽  
Uterine Sarcomas ◽  
Free Survival ◽  
Stromal Sarcoma ◽  
Significant Difference ◽  
Disease Free

Abstract Background：Tumor morcellation happened to facilitate iatrogenic metastasis for patients with occult uterine sarcoma. The optimal remedial procedure for these patients needed to be established. Methods：Data were retrospectively collected and analyzed from patients with occult uterine sarcoma undergoing morcellation. Results：23 consecutive patients with uterine sarcomas undergoing morcellation were accessed between Jan 2008 and Dec 2018, including 15 patients with uterine leiomyosarcoma and 8 with endometrial stromal sarcoma. Hysterectomy + omentectomy as a remedial procedure was significantly associated with better disease-free survival (P=0.031), and all 7 patients undergoing the previous procedure remain disease free. However, nether simple hysterectomy (P=0.194) nor adjuvant therapy (P=0.159) had such benefits. There was no significant difference in disease-free survival between laparoscopic and open surgery (p=0.321). Conclusion：Hysterectomy + omentectomy was considered as the optimal remedial procedure for patients with occult uterine sarcoma undergoing morcellation.

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

2008 ◽  
Vol 18 (5) ◽  
pp. 1084-1089 ◽  
Author(s):  
W. Y. Kim ◽  
J.-W. Lee ◽  
C. H. Choi ◽  
H. Kang ◽  
T.-J. Kim ◽  
...  
Keyword(s):  
Disease Free Survival ◽  
Endometrial Stromal Sarcoma ◽  
Disease Recurrence ◽  
Primary Treatment ◽  
Stage I ◽  
Low Grade ◽  
Stromal Sarcoma ◽  
Case Surgery ◽  
Abnormal Vaginal Bleeding ◽  
Disease Free

The aim of this retrospective study was to evaluate the clinical behavior and management outcome of low-grade endometrial stromal sarcoma (LGESS). From September 1994, to March 2007, 22 patients with histologically proven stage I LGESS were included in this study. Clinicopathologic variables, recurrence, and management outcomes were reviewed retrospectively. The median age of the 22 patients was 43 years. The most common presenting symptom was abnormal vaginal bleeding. All patients underwent a hysterectomy and had stage I disease. Six patients had adjuvant therapy after the hysterectomy. The median follow-up period was 77 months (range 12–202 months). Ten patients had disease recurrence. The median disease-free survival period was 111 months (range 6–182 months). The pelvis (eight cases) was the most common site of recurrence followed by the lung (four cases) and the liver (one case). Recurrent disease was treated with surgery (one case), surgery plus chemotherapy (five cases), chemotherapy (two cases), and surgery plus radiotherapy (two cases). Two patients died after 25 and 54 months after disease recurrence. Treatment with a bilateral salpingo-oophorectomy or adjuvant chemoradiation did not affect the disease-free interval. LGESS is usually a slow-growing neoplasm with an indolent clinical course. Surgery is the primary treatment for recurrent endometrial stromal sarcoma when feasible. Adjuvant treatment (radiotherapy, chemotherapy, or both) had no effect on the prognosis of patients with stage I disease

scholarly journals Endometrial stromal sarcoma in a 20-year-old woman

2019 ◽  
Vol 12 (12) ◽  
pp. e228874
Author(s):  
Rubina Sohail ◽  
Shahlla Kanwal ◽  
Adnan Murtaza ◽  
Bushra Haq
Keyword(s):  
Adnexal Mass ◽  
Stage Iv ◽  
Endometrial Stromal Sarcoma ◽  
Final Diagnosis ◽  
Sexually Active ◽  
Uterine Sarcomas ◽  
Stromal Sarcoma ◽  
Pelvic Wall ◽  
The Right

Endometrial stromal sarcoma (ESS) is an uncommon and challenging condition comprising 10% of all uterine sarcomas and found in women 42–58 years of age. ESS is difficult to diagnose in young women as it masquerades as a leiomyoma. We report this tumour in a 20-year-old woman presenting with heavy and prolonged menses and urinary retention. She was not sexually active and did not give consent for pelvic examination. A preoperative diagnosis of a submucous leiomyoma with an adnexal mass was made. At laparotomy, the leiomyoma was found to be wedged between the cervix and the vagina, and was removed vaginally. A 5–6 cm retroperitoneal mass was adherent to the right pelvic wall, which was also removed. Histopathology of both specimens revealed ESS. The final diagnosis according to the International Federation of Gynaecology and Obstetrics classification was stage IV ESS. After oncology consult, she was referred for chemotherapy. She is now on follow-up.

Long-term disease-free survival after hormonal therapy of a patient with recurrent low grade endometrial stromal sarcoma: a case report

2008 ◽  
Vol 279 (1) ◽  
pp. 57-60 ◽  
Author(s):  
Özkan Alkasi ◽  
Ivo Meinhold-Heerlein ◽  
Rania Zaki ◽  
Peter Fasching ◽  
Nicolai Maass ◽  
...  
Keyword(s):  
Case Report ◽  
Hormonal Therapy ◽  
Disease Free Survival ◽  
Endometrial Stromal Sarcoma ◽  
Low Grade ◽  
Free Survival ◽  
Stromal Sarcoma ◽  
Disease Free

Does iatrogenic tumor rupture during surgery have prognostic implications for the outcome of uterine sarcomas?

2020 ◽  
Vol 30 (11) ◽  
pp. 1726-1732
Author(s):  
Virginia Benito ◽  
Amina Lubrano ◽  
Laureano León ◽  
Fernando Molano ◽  
Beatriz Pinar
Keyword(s):  
Uterine Rupture ◽  
Survival Rates ◽  
Disease Free Survival ◽  
Endometrial Stromal Sarcoma ◽  
Uterine Sarcoma ◽  
Tumor Rupture ◽  
Uterine Sarcomas ◽  
Free Survival ◽  
Stromal Sarcoma ◽  
Gynecology And Obstetrics

ObjectiveTumor rupture during surgery is a risk factor for recurrence of sarcomas in other locations. However, the independent impact of rupture on prognosis is uncertain in uterine sarcomas. The aim of this study was to evaluate whether uterine rupture impacts outcomes in patients with uterine sarcoma.MethodsA retrospective analysis was carried out of all consecutive patients with uterine sarcoma managed at the Department of Gynecology and Obstetrics of the Complejo Hospitalario Universitario Insular-Materno Infantil of the Canary Islands, Spain between January 1990 and December 2016. Inclusion criteria included all patients with histologically proven uterine sarcoma. Exclusion criteria included patients with endometrial carcinoma (non-sarcomatous) and carcinosarcomas. During this period, 1981 patients were diagnosed with a uterine malignancy; 1799 were excluded because of a diagnosis of endometrial carcinoma and 85 patients were excluded for a diagnosis of carcinosarcoma. Thus, the final sample included 97 patients with uterine sarcoma (4.9%). These included leiomyosarcoma, endometrial stromal sarcoma, adenosarcoma, and liposarcoma. Surgical resection was the primary treatment, including open, laparoscopic and vaginal surgery. Survival rates were analyzed using the Kaplan–Meier method.ResultsThe median age was 52 years (range 25–90); 49.5% (48) were pre-menopausal. Distribution per histological type was: 46.4% (45) leiomyosarcoma, 23.7% (23) high-grade endometrial stromal sarcoma, 17.5% (17) low-grade endometrial stromal sarcoma, 11.3% (11) adenosarcoma, and 1% (1) liposarcoma. Uterine leiomyoma was the most frequent pre-operatively suspected diagnosis (49.5%). Iatrogenic rupture of the tumor during surgery occurred in 25.3% of cases (23). International Federation of Gynecology and Obstetrics stages I–II and III–IV were identified in 74.2% (72) and 25.8% (25) of patients, respectively. The median tumor size was 8 cm (range 2–40). The recurrence rate was 47.8% (11) for patients with intra-operative tumor rupture and 25% (17) for patients without uterine rupture (p=0.03). Disease-free survival rates at 1, 2, and 5 years for patients with uterine rupture were 72.7%, 55.4%, and 13.9%, respectively, with a median time of 39 months (95% CI 2.9 to 75). For those patients without uterine rupture, disease-free survival rates at 1, 2, and 5 years were 84.8%, 76.1%, and 71.3%, respectively, with a mean time of 208.6 months (95% CI 169 to 248.3) (p=0.01). Multivariate analysis showed that stage, histological type, and iatrogenic tumor rupture during surgery were all independent prognostic factors for overall survival (OR 7.9, 95% CI 1.6 to 38.2, p=0.01); OR 5.3, 95% CI 2.1 to 13, p<0.0001; and OR 2.6, 95% CI 1.1 to 6.5, respectively, p=0.03).ConclusionConsidering that uterine sarcomas, especially leiomyosarcomas, often occur in pre-menopausal women as bulky tumors requiring laparotomy and that they are rarely diagnosed pre-operatively, efforts should be made to avoid iatrogenic uterine rupture during surgery as it impairs patient survival.

scholarly journals Adjuvant Radiotherapy Improved Survival in Stage I to II Low-Grade Endometrial Stromal Sarcoma: A Retrospective Study of 152 Cases

2021 ◽  
Vol 10 ◽  
Author(s):  
Wenhui Wang ◽  
Shuai Sun ◽  
Zheng Miao ◽  
Xiaorong Hou ◽  
Fuquan Zhang ◽  
...  
Keyword(s):  
Adjuvant Radiotherapy ◽  
Early Stage ◽  
Postoperative Radiotherapy ◽  
Disease Free Survival ◽  
Endometrial Stromal Sarcoma ◽  
Stage I ◽  
Low Grade ◽  
Free Survival ◽  
Stage Ib ◽  
Stromal Sarcoma

ObjectiveLow-grade endometrial stromal sarcoma (LG-ESS) is a rare gynecological tumor. Whether adjuvant radiotherapy benefits survival in patients with resected early-stage ESS remains controversial. This study was designed to explore the role of adjuvant radiotherapy in stage I to II LG-ESS.MethodsWe retrospectively reviewed patients with stage I to II LG-ESS in our center from Jan. 1998 to Feb. 2018. All patients underwent a total hysterectomy and postoperative radiotherapy was administrated based on clinical and pathological characteristics.ResultsA total of 152 patients with stage I to II resected LG-ESS were included. Forty patients received adjuvant radiotherapy (RT group) while 112 patients did not receive adjuvant radiotherapy (no RT group). The baseline characteristics of the two groups were comparable, except that the proportion of stage II patients in the RT group was higher than that in the no RT group (32.5% vs. 11.6%, in RT vs. no RT groups, respectively; p = 0.003). For both patient groups, median overall survival was not reached. The median disease-free survival (DFS) was 144 months. Radiotherapy was associated with significantly improved DFS (92 months vs. not reached in RT vs. no RT groups, respectively; p = 0.008) and pelvic failure-free survival (PFFS) (92 months vs. not reached in RT vs. no RT groups, respectively; p=0.004). Subgroup analysis revealed that RT benefited survival most among patients with stage IB to IIB disease. Adjuvant radiotherapy significantly reduced the pelvic recurrence rate (10.0%, 4/40 vs. 28.6%, 32/112, p = 0.018). No radiotherapy-induced grade 4 to 5 toxicity was observed.ConclusionFor patients with stage I to II LG-ESS, adjuvant radiotherapy showed significant improvement in DFS and PFFS with tolerable adverse effects, especially in patients with stage IB to IIB disease.

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