scholarly journals The prognosis of recurrent low-grade endometrial stromal sarcoma: a retrospective cohort study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Qianwen Dai ◽  
Baolin Xu ◽  
Huanwen Wu ◽  
Yan You ◽  
Ming Wu ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Univariate Analysis ◽  
Endometrial Stromal Sarcoma ◽  
Hormone Treatment ◽  
Low Grade ◽  
Ovarian Preservation ◽  
Stromal Sarcoma ◽  
Fertility Sparing ◽  
First Recurrence

Abstract Background The prognosis of recurrent low-grade endometrial stromal sarcoma (LGESS) is little known. This study was to investigate the survival outcomes of a cohort of patients with recurrent LGESS. Methods Patients with primary LGESS diagnosed and treated for first recurrence confirmed by histology in the study center from February 2012 to June 2019 were retrospectively included. The progression-free interval (PFI) after the last treatment for first recurrence and overall survival (OS) since the diagnosis of first recurrence, which were followed up to June 1, 2020, were compared between groups of various therapy modalities. Results Fifty-six patients were included, and 43 patients (76.8%) had definite follow-up outcomes. The 5-year PFI and OS rates were 30.0% (95% confidence interval [95% CI] 29.2–30.8) and 75.0% (68.0–82.0), respectively. In univariate analysis, only fertility-sparing treatment, ovarian preservation and surgical treatment had a significant impact on the PFI (hazard ratio [HR] 4.5, 3.1, and 0.2; 95% CI 1.5–13.1, 1.3–7.3, and 0.1–0.7; and p = 0.006, 0.009 and 0.006, respectively), but no factor was found to be associated with increased mortality risk. After adjusted with hormone treatment or chemotherapy, surgical treatment had significant effectiveness on OS (HR 0.3 and 0.3, 95% CI 0.1–1.0 and 0.1–1.0, p = 0.045 and 0.049, respectively). None of the patients with fertility-sparing treatment had successful conception, and all experienced repeated relapse. Conclusion For patients with recurrent LGESS, fertility-sparing treatment or ovarian preservation should not be provided. Surgery is the treatment of choice, and hormone treatment and/or chemotherapy was effective for the survival benefits of surgical treatment.

scholarly journals Reversion of Hormone Treatment Resistance with the Addition of an mTOR Inhibitor in Endometrial Stromal Sarcoma

2014 ◽  
Vol 2014 ◽  
pp. 1-5 ◽  
Author(s):  
J. Martin-Liberal ◽  
C. Benson ◽  
C. Messiou ◽  
C. Fisher ◽  
I. Judson
Keyword(s):  
Hormone Receptors ◽  
Mtor Inhibitor ◽  
Acquired Resistance ◽  
Mammalian Target Of Rapamycin ◽  
Treatment Resistance ◽  
Endometrial Stromal Sarcoma ◽  
Hormone Treatment ◽  
Mtor Pathway ◽  
Low Grade ◽  
Stromal Sarcoma

Background. Endometrial stromal sarcomas (ESS) are a subtype of gynaecological sarcomas characterized by the overexpression of hormone receptors. Hormone treatment is widely used in ESS but primary or acquired resistance is common. The mammalian target of rapamycin (mTOR) pathway has been suggested to play a key role in the mechanisms of hormone resistance. Recent studies in breast and prostate cancer demonstrate that this resistance can be reversed with the addition of an mTOR inhibitor. This phenomenon has never been reported in ESS.Methods. We report the outcome of one patient with pretreated, progressing low grade metastatic ESS treated with medroxyprogesterone acetate in combination with the mTOR inhibitor sirolimus.Results. Partial response was achieved following the addition of sirolimus to the hormone treatment. Response has been maintained for more than 2 years with minimal toxicity and treatment is ongoing.Conclusion. This case suggests that the resistance to the hormone manipulation in ESS can be reversed by the addition of an mTOR pathway inhibitor. This observation is highly encouraging and deserves further investigation.

Ovarian preservation for low-grade endometrial stromal sarcoma: a systematic review of the literature and meta-analysis

2019 ◽  
Vol 29 (1) ◽  
pp. 126-132 ◽  
Author(s):  
Dimitrios Nasioudis ◽  
Emily M Ko ◽  
Georgios Kolovos ◽  
Stylianos Vagios ◽  
Dimitrios Kalliouris ◽  
...  
Keyword(s):  
Recurrence Rate ◽  
Death Rate ◽  
Tumor Recurrence ◽  
Meta Analysis ◽  
Endometrial Stromal Sarcoma ◽  
Oncologic Outcomes ◽  
Low Grade ◽  
Ovarian Preservation ◽  
Stromal Sarcoma ◽  
Meta Analyses

ObjectiveTo evaluate the effect of ovarian preservation on oncologic outcomes for women with low-grade endometrial stromal sarcoma of the uterus.MethodsA systematic search of the Medline, Embase, Cohrane, and Web of Science databases was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Studies including patients with low-grade endometrial stromal sarcoma who had hysterectomy were identified. Data on tumor recurrence and death rate were pooled using a random effects model.ResultsA total of 17 studies met the inclusion criteria and reported on 786 patients. Based on available information, ovarian preservation was noted in 190 patients while 501 had bilateral salpingo-oophorectomy. A significantly increased tumor recurrence rate was observed in the ovarian preservation group (89/190, 46.8%) compared with the bilateral salpingo-oophorectomy group (121/501, 24.2%) (OR 2.70, 95% CI 1.39 to 5.28). Based on data from 162 patients, no difference in death rate was noted between the ovarian preservation (2/34, 5.9%) and bilateral salpingo-oophorectomy (9/128, 7%) groups (OR 0.80, 95% CI 0.18 to 3.47).ConclusionsApproximately one-quarter of patients with low-grade endometrial stromal sarcoma were managed with ovarian preservation. These women experienced a higher recurrence rate. Hormone exposure may be responsible for this elevated risk. Given the apparent high salvage rate, however, ovarian preservation may be an option only in a well-informed patient population.

Does ovarian preservation have an effect on recurrence of early stage low-grade endometrial stromal sarcoma?

2020 ◽  
pp. 1-6
Author(s):  
Volkan Karataşlı ◽  
İlker Çakır ◽  
Behzat Can ◽  
Selçuk Erkılınç ◽  
Tuğba Karadeniz ◽  
...  
Keyword(s):  
Early Stage ◽  
Endometrial Stromal Sarcoma ◽  
Low Grade ◽  
Ovarian Preservation ◽  
Stromal Sarcoma

Lymphadenectomy and Ovarian Preservation in Low-Grade Endometrial Stromal Sarcoma

2008 ◽  
Vol 112 (5) ◽  
pp. 1102-1108 ◽  
Author(s):  
Jay P. Shah ◽  
Christopher S. Bryant ◽  
Sanjeev Kumar ◽  
Rouba Ali-Fehmi ◽  
John M. Malone ◽  
...  
Keyword(s):  
Endometrial Stromal Sarcoma ◽  
Low Grade ◽  
Ovarian Preservation ◽  
Stromal Sarcoma

scholarly journals Low-grade Endometrial Stromal Sarcoma with Intracaval or Intracardiac Extension: A Retrospective Study of 8 Cases

2021 ◽  
Author(s):  
Junyu Chen ◽  
Jinhui Wang ◽  
Dongyan Cao ◽  
Jiaxin Yang ◽  
Huifang Huang ◽  
...  
Keyword(s):  
Endometrial Stromal Sarcoma ◽  
Abnormal Uterine Bleeding ◽  
Lower Limbs ◽  
High Rate ◽  
Histological Evaluation ◽  
Low Grade ◽  
College Hospital ◽  
Stromal Sarcoma ◽  
Intracardiac Extension

Abstract Purpose: This study aimed to improve the knowledge of low-grade endometrial stromal sarcoma (LG-ESS) with intracaval or intracardiac extension and tried to identify the potential risk factors and optimal treatment method influencing prognosis.Methods: We performed a retrospective review of eight LG-ESS patients with intracaval or intracardiac extension who underwent treatment at Peking Union Medical College Hospital between 2012 and 2020.Results: The median age at diagnosis was 44 years, ranging from 28 to 56 years. Abnormal uterine bleeding was the most common intimal symptom (3/8), followed by low back discomfort (2/8), edema of the lower limbs (2/8), abdominal pain (1/8), and dyspnea (1/8). All patients underwent resection of the intravascular and extravascular portions of the tumor. Two patients were in stage IIIC, and 6 were in stage IVB. After surgery, 4 patients received adjuvant radiotherapy, of whom 3 also received letrozole. One patient was treated with letrozole alone, and 1 patient received medroxyprogesterone. The average follow-up time was 34.5 months, ranging from 6 to 98 months. No patients died or relapsed during the follow-up period.Conclusions: LG-ESS with intracaval or intracardiac extension is an uncommon type of tumor which is easily misdiagnosed and can only be diagnosed by histological evaluation after surgery. Complete tumoral excision followed by adjuvant therapy may benefit patient survival time. Long-term follow-up is essential due to the high rate of late recurrence.

scholarly journals Endometrial stromal sarcoma: a rare form of undifferentiated endometrial cancer

2021 ◽  
Author(s):  
Dolly Mehra ◽  
Anjum Saiyyed
Keyword(s):  
Endometrial Stromal Sarcoma ◽  
Good Prognosis ◽  
Low Grade ◽  
Repeat Surgery ◽  
Stromal Sarcoma ◽  
Long Term Follow Up ◽  
Uterine Cancers

Uterine sarcomas are a rare for of uterine cancers. They account for 0.2% of uterine cancers. The median age group is 40 to 60 years. They run an indolent course. About 60% women recur after a long period. Metastasis may occur even after 20 years. They can be classified into low grade, high grade and undifferentiated types. Low grade ESS has good prognosis. Surgery with adjuvant hormonal therapy is the mainstay of treatment. Adjuvant radiotherapy and chemotherapy have no role in management. The role of lymphadenectomy is not clear. The first line treatment for recurrence is a repeat surgery. Patients require a long term follow up to detect recurrence. Here we present a case of perimenopausal women presenting as a case of AUB. MRI initially diagnosed it as a case of fibroid. Patient underwent TAH with BSO. Subsequent hispathology and immunohistochemistry revealed it to be Low grade ESS. Although rare, endometrial stromal sarcoma should be considered as a differential diagnosis in perimenopausal and postmenopausal women presenting as AUB.

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