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Livi L, Paiar F, Meldolesi E, Simontacchi G, Amunni G, Barca R, Villanucci A, Scoccianti S, Piperno G, Biti G. Treatment of Uterine Sarcoma at the University of Florence from 1980-2001. TUMORI JOURNAL 2019; 91:139-43. [PMID: 15948541 DOI: 10.1177/030089160509100207] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose To correlate the treatment used in uterine sarcoma with outcome. The prognostic importance of pathology, clinical parameters and treatment are analyzed. Patients and methods Forty patients (median age, 59 years; range, 37-85) with histologically verified uterine sarcoma were identified from a database compiled at the University of Florence from 1980 to 2001. Patients were followed for a median of 54 months (range, 3 months to 10 years). Twenty-four patients had leiomyosarcoma, 12 patients had mixed mullerian tumors, and 3 patients had endometrial stromal sarcoma. Stage I, II, III and IV tumors were identified in 22, 2, 9 and 7 patients, respectively. High, intermediate, low and unspecified grade sarcoma occurred in 9, 4, 5 and 22 patients, respectively. Results At the time of analysis, 58% of patients had died and 42% were alive, with a median survival of 2 years from the initial diagnosis. Cause-specific survival for the entire group was 81%, 41% and 25% at 1, 3 and 5 years, respectively. In our series, univariate analysis for cause-specific survival did not demonstrate statistical significance for histology, grade, stage or age. There appeared to be a significant impact for postoperative radiotherapy in reducing local recurrence with a total dose higher than 50 Gy. Conclusions Our data favor treatment for uterine sarcoma with radical surgery plus irradiation, even in elderly patients.
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Affiliation(s)
- Lorenzo Livi
- Radiotherapy Department, Florence University, Florence, Italy.
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Etiz D, Garipağaoğlu M, Etiz EE, Köse FM, Kayikçioğlu F, Haberal A, Citak L, Cakmak A. Results of Postoperative Radiotherapy in the Treatment of 29 Uterine Sarcoma Patients. TUMORI JOURNAL 2018; 89:183-8. [PMID: 12841668 DOI: 10.1177/030089160308900215] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and background The objective of this study was to evaluate the results of surgery combined with postoperative radiotherapy (RT) in patients with uterine sarcoma in order to describe the patterns of relapse and to define prognostic factors. Methods We report on 29 patients with uterine sarcoma (US) treated from 1980 to 1995; 18 patients with primary tumors were treated with surgery and adjuvant irradiation, while 11 patients with local recurrences (LR) after previous surgical resection received only radiotherapy. We evaluated the influence of stage, histology, grade, menopausal status, total radiation dose and brachytherapy on survival. Histological diagnosis was leiomyosarcoma in 13 patients (44.8%), endometrial stromal sarcoma in 10 patients (34.5%), and mixed mesodermal tumors in six patients (20.7%). Fifteen patients presented with stage I-II disease, three with stage III, and 11 with local recurrences. External pelvic RT was administered to all patients, in five patients combined with brachytherapy. The mean total dose was 54 Gy (SE 1.78). Univariate and multivariate analyses were carried out. Results Overall survival (OS) for the stage I-III group was 61.1% at two years and 33.3% at five years (median 29 months, SE 13.79). Disease-free survival (DFS) was 55.6% at two years and 33.3% at five years. Median DFS was 26 months (SE 14.85). In LR cases, median OS was only 10 months (SE 4.5). Multivariate analysis demonstrated that stage was the only prognostic factor after RT for US. Conclusions These data suggest that postoperative and/or salvage RT has a questionable impact on disease-free and overall survival because of the lack of homogeneity of stages in the series reported in the literature; it has, however, acceptable late side effects. Prospective multicenter trials including a statistically evaluable number of patients are necessary to further clarify the role of RT treatment programs for US.
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Affiliation(s)
- Durmuş Etiz
- Department of Radiation Oncology, Osmangazi University, Faculty of Medicine, Eskişehir, Turkey.
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Annede P, Gouy S, Mazeron R, Bentivegna E, Maroun P, Petit C, Dumas I, Leary A, Genestie C, Lhommé C, Deutsch E, Morice P, Pautier P, Haie-Meder C, Chargari C. Optimizing Local Control in High-Grade Uterine Sarcoma: Adjuvant Vaginal Vault Brachytherapy as Part of a Multimodal Treatment. Oncologist 2017; 22:182-188. [PMID: 28174295 DOI: 10.1634/theoncologist.2016-0204] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 08/18/2016] [Indexed: 11/17/2022] Open
Abstract
PURPOSE The phase III European Organization for Research and Treatment of Cancer 55874 study has shown that external beam radiotherapy (EBRT) given as adjuvant treatment decreased locoregional recurrences from 40% to 20% in patients (pts) with localized uterine sarcomas (US). No data exist, however, on the place of brachytherapy (BT). MATERIAL AND METHODS We conducted a single-center retrospective analysis of pts receiving adjuvant BT of the vaginal vault based on the vaginal mold technique as part of their multimodal adjuvant treatment for a high-grade US from 1985 to 2015. Treatment characteristics, patterns of relapse, and toxicity were examined. RESULTS Median follow-up time was 5.5 years. A total of 98 pts with high-grade US were identified: 81 leiomyosarcomas and 17 undifferentiated sarcomas. Postoperative chemotherapy was delivered in 53 pts. Median dose of EBRT was 45 Gy in 25 fractions. High-dose rate, low-dose rate, and pulsed-dose rate techniques were used in 66, 31, and 1 pts, respectively. At last follow-up, six pts (6.1%) experienced a locoregional relapse as first event. The International Federation of Gynecology and Obstetrics stage and the tumor size were associated with a higher probability of local relapse. When focusing on pts with stage I-III disease, 5-year overall survival was 77% (95% confidence interval: 67%-87%) and 5-year survival without locoregional failure was 91% (83%-98%). Toxicities were mild to moderate, with only four acute grade 3 toxicities and two grade 3 late effects. CONCLUSION Vaginal vault BT as part of a multimodal adjuvant treatment was associated with a high locoregional control rate and with acceptable side effects in localized high-grade US. The Oncologist 2017;22:182-188Implications for Practice: This study suggests that an aggressive adjuvant treatment combining chemotherapy and pelvic external beam radiotherapy followed with a brachytherapy of the vaginal vault is associated with a high locoregional control rate and an acceptable toxicity rate in patients with high grade uterine sarcoma. Adding a brachytherapy boost could also allow deescalating the total dose of pelvic external beam radiotherapy, in order to decrease the side effects of adjuvant treatment in these patients without increasing the risk of local relapse. However, the prognosis remains determined by a high frequency of systemic relapses.
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Affiliation(s)
- Pierre Annede
- Brachytherapy Unit, Gustave Roussy, Villejuif, France
- Department of Radiotherapy, Gustave Roussy, Villejuif, France
| | - Sébastien Gouy
- Department of Surgery, Gustave Roussy, Villejuif, France
| | - Renaud Mazeron
- Brachytherapy Unit, Gustave Roussy, Villejuif, France
- Department of Radiotherapy, Gustave Roussy, Villejuif, France
- INSERM 1030, Gustave Roussy Cancer Campus, Villejuif, France
| | | | - Pierre Maroun
- Brachytherapy Unit, Gustave Roussy, Villejuif, France
- Department of Radiotherapy, Gustave Roussy, Villejuif, France
| | - Claire Petit
- Brachytherapy Unit, Gustave Roussy, Villejuif, France
- Department of Radiotherapy, Gustave Roussy, Villejuif, France
| | - Isabelle Dumas
- Brachytherapy Unit, Gustave Roussy, Villejuif, France
- Department of Radiotherapy, Gustave Roussy, Villejuif, France
| | - Alexandra Leary
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | | | - Catherine Lhommé
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - Eric Deutsch
- Department of Radiotherapy, Gustave Roussy, Villejuif, France
- INSERM 1030, Gustave Roussy Cancer Campus, Villejuif, France
- Université Paris-Sud, SIRIC SOCRATES, Faculté de Médecine, Le Kremlin-Bicetre, France
| | - Philippe Morice
- Department of Surgery, Gustave Roussy, Villejuif, France
- Université Paris-Sud, SIRIC SOCRATES, Faculté de Médecine, Le Kremlin-Bicetre, France
| | - Patricia Pautier
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - Christine Haie-Meder
- Brachytherapy Unit, Gustave Roussy, Villejuif, France
- Department of Radiotherapy, Gustave Roussy, Villejuif, France
- INSERM 1030, Gustave Roussy Cancer Campus, Villejuif, France
| | - Cyrus Chargari
- Brachytherapy Unit, Gustave Roussy, Villejuif, France
- Department of Radiotherapy, Gustave Roussy, Villejuif, France
- INSERM 1030, Gustave Roussy Cancer Campus, Villejuif, France
- Institut de Recherche Biomédicale des Armées, Brétigny-sur-Orge, France
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Burghaus S, Halmen S, Gass P, Mehlhorn G, Schrauder MG, Lux MP, Renner SP, Beckmann MW, Hein A, Thiel FC. Outcome and prognosis in uterine sarcoma and malignant mixed Mullerian tumor. Arch Gynecol Obstet 2015; 294:343-51. [PMID: 26711836 DOI: 10.1007/s00404-015-3993-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 12/10/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE There is low evidence regarding the optimal treatment in patients with uterine sarcomas and malignant mixed Mullerian tumors (MMMTs). This study provides an overview of experience at our center with patients diagnosed with uterine sarcoma and MMMT, in relation to the clinical management and outcome. METHODS The medical records for 143 patients with low-grade endometrial stromal sarcoma (ESS), leiomyosarcoma (LMS), and high-grade (undifferentiated) endometrial sarcoma (UES) and MMMT were reviewed. All available clinical and pathological data were collected and analyzed. Putative prognostic factors were entered into a multivariate analysis using a Cox proportional hazards ratio model, and survival data were calculated. RESULTS The 5-year overall survival rates were significantly different between patients with ESS, LMS, and UES and MMMT (86 vs. 40 vs. 57 vs. 45 %; P < 0.001). The multivariate analysis showed that the patients' age, higher FIGO stage (III-IV), a history of smoking, prior pelvic radiation, diabetes, and residual tumor after surgery were associated with a poorer overall survival. Histological subtypes of LMS (HR 4.68; 95 % CI 1.35-16.17), UES (HR 1.21; 95 % CI 0.26-5.77) and MMMT (HR 1.63; 95 % CI 0.42-6.43) were also associated with a poorer overall survival than ESS (P = 0.008). Adjuvant therapies showed no associations with overall survival. CONCLUSIONS Adjuvant therapy has so far not shown any overall survival benefit, and the focus is therefore on primary surgery. In future studies, the entities should be investigated separately in relation to prognostic factors and effective therapeutic management.
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Affiliation(s)
- Stefanie Burghaus
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany.
| | - Sonja Halmen
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Paul Gass
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Grit Mehlhorn
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Michael G Schrauder
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Michael P Lux
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Stefan P Renner
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Alexander Hein
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany
| | - Falk C Thiel
- Department of Gynecology and Obstetrics, Comprehensive Cancer Center Erlangen-EMN, Erlangen University Hospital, Friedrich Alexander University of Erlangen-Nuremberg, Universitätsstrasse 21-23, 91054, Erlangen, Germany.,ALB FILS KLINKEN GmbH, Goeppingen, Germany
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5
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Han Y, Li S, Holt HK, Wu L. Curative effect of bevacizumab combined with chemotherapy in advanced or recurrent uterine sarcoma. Mol Clin Oncol 2015; 4:245-248. [PMID: 26893869 DOI: 10.3892/mco.2015.709] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 11/23/2015] [Indexed: 12/20/2022] Open
Abstract
The aim of this study was to investigate the clinical effect of bevacizumab (BEV) combined with chemotherapy in advanced or recurrent uterine sarcoma. The clinical data of 4 patients with advanced or recurrenct uterine sarcoma, who received treatment with BEV combined with chemotherapy in our hospital between May, 2006 and May, 2014, were retrospectively analyzed. We estimated the chemotherapy response rate [complete response (CR) + partial response (PR)], clinical benefit rate [CR + PR+ stable disease (SD)], progression-free survival (PFS) and overall survival (OS), and evaluated treatment safety and toxicity reactions. Of the 4 patients, 1 achieved CR, with a disease-free survival time of 96 months; 1 achieved PR, with a PFS of 13 months and an OS of 25 months; 1 achieved SD, with a PFS of 9 months and an OS of 24 months; and 1 developed progressive disease, with a PFS of 3 months and an OS of 9 months. The response rate (CR+PR) was 50%, and the clinical benefit rate (CR+PR+SD) was 75%. Treatment-related adverse reactions occurred in all 4 patients, including bone marrow suppression and gastrointestinal reactions. Of the 4 patients, 1 developed grade 4 bone marrow suppression (thrombocytopenia), whereas the remaining 3 patients developed grade 2 bone marrow suppression (leukopenia). Of the 4 cases, 2 developed grade 2 gastrointestinal reactions, and the remaining 2 patients grade 1 gastrointestinal reactions. Therefore, BEV combined with chemotherapy was able to effectively control advanced or recurrent uterine sarcoma, was well-tolerated, and is considered to be a safe and effective candidate treatment for this type of tumor.
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Affiliation(s)
- Ying Han
- Department of Gynecologic Oncology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, P.R. China
| | - Shumin Li
- Department of Gynecologic Oncology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, P.R. China
| | - Hunter K Holt
- Medical College, Rush University, Chicago, IL 60612, USA
| | - Lingying Wu
- Department of Gynecologic Oncology, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, P.R. China
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Ryu H, Choi YS, Song IC, Yun HJ, Jo DY, Kim S, Lee HJ. Long-term treatment of residual or recurrent low-grade endometrial stromal sarcoma with aromatase inhibitors: A report of two cases and a review of the literature. Oncol Lett 2015; 10:3310-3314. [PMID: 26722331 DOI: 10.3892/ol.2015.3674] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Accepted: 08/17/2015] [Indexed: 11/06/2022] Open
Abstract
Endometrial stromal sarcoma (ESS) occurs rarely and accounts for only 0.2% of all uterine malignancies. ESS usually expresses estrogen and progesterone receptors, and is regarded as hormone-sensitive. Due to the rarity of these tumors, there are only few case series on the use of aromatase inhibitors in the treatment of low-grade ESS. The present study reports the cases of two patients with residual or recurrent low-grade ESS who experienced long-term disease-free survival following treatment with letrozole. The study also reviews the literature with regard to the data on aromatase inhibitors used in patients with low-grade ESS. In total, 30 patients with recurrent or residual low-grade ESS who were treated with aromatase inhibitors were identified, including the present cases. Among the 30 patients, the overall response rate of advanced low-grade ESS to aromatase inhibitors was 77.4% (complete response, 25.8%; partial response, 51.6%) and the disease control rate was 90.3%. The response rate of first-line treatment was similar to that of second-line therapy or higher (84.6 vs. 72.2%; P=0.453). Duration of aromatase inhibitor treatment ranged from 1.5 to 168 months (median, 26.5 months). The aromatase inhibitors showed minimal adverse effects. In conclusion, aromatase inhibitors, particularly third-generation drugs, are a well-tolerated class of medications that are effective in the treatment of advanced low-grade ESS, with a favorable toxicity profile.
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Affiliation(s)
- Hyewon Ryu
- Division of Hematology-Oncology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon 301-721, Republic of Korea
| | - Yoon-Seok Choi
- Division of Hematology-Oncology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon 301-721, Republic of Korea
| | - Ik-Chan Song
- Division of Hematology-Oncology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon 301-721, Republic of Korea
| | - Hwan-Jung Yun
- Division of Hematology-Oncology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon 301-721, Republic of Korea
| | - Deog-Yeon Jo
- Division of Hematology-Oncology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon 301-721, Republic of Korea
| | - Samyong Kim
- Division of Hematology-Oncology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon 301-721, Republic of Korea
| | - Hyo Jin Lee
- Division of Hematology-Oncology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon 301-721, Republic of Korea
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Hou HL, Meng MB, Chen XL, Zhao LJ, Zhu L, Zhang BL, Wang P. The prognosis factor of adjuvant radiation therapy after surgery in uterine sarcomas. Onco Targets Ther 2015; 8:2339-44. [PMID: 26357482 PMCID: PMC4559239 DOI: 10.2147/ott.s88186] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objective This retrospective study evaluated the role of adjuvant radiotherapy (AR) after surgery in patients with uterine sarcoma and analyzed the prognostic factors of local-regional failure-free survival (LRFFS) and overall survival (OS). Patients and methods A study of a total of 182 patients with uterine sarcoma was conducted between June 1994 and October 2014. Adjuvant radiotherapy was defined as postoperative external beam radiation to the pelvis (30–50 Gray/10–25 fractions at five fractions/week). The primary end point was LRFFS, and the secondary end point was OS. Kaplan–Meier curves were compared using the log-rank test. Cox regression analyses were used to determine prognosticators for LRFFS and OS. Results The median follow-up time of all patients was 75 months, with a 5-year LRFFS of 62.1%. The 2-year and 5-year LRFFS rates were longer for those who received AR than for those who did not receive AR (83.4% vs 70.3%; 78% vs 55.3%; P=0.013). The 5-year OS of all patients was 56.2%, and no significant differences were observed in the 2-year and 5-year OS rates between these two groups (82.7% vs 71.4%; 64.1% vs 51.7%; P=0.067). Importantly, in patients with leiomyosarcoma, the 2-year and 5-year LRFFS and OS rates were longer for those who received AR than for those who did not receive AR (P=0.04 and P=0.02 for the 2-year and 5-year LRFFS, respectively). Conclusion Patients with uterine sarcoma who were treated with AR after surgery demonstrated an improved LRFFS compared with those who were treated with surgery alone, especially those patients with leiomyosarcoma. Therefore, the role of personalized adjuvant radiation for patients with uterine sarcoma still requires further discussion.
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Affiliation(s)
- Hai-Ling Hou
- Department of Radiation Oncology, CyberKnife Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, People's Republic of China
| | - Mao-Bin Meng
- Department of Radiation Oncology, CyberKnife Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, People's Republic of China
| | - Xiu-Li Chen
- Department of Radiation Oncology, CyberKnife Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, People's Republic of China
| | - Lu-Jun Zhao
- Department of Radiation Oncology, CyberKnife Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, People's Republic of China
| | - Li Zhu
- Department of Radiation Oncology, CyberKnife Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, People's Republic of China
| | - Bai-Lin Zhang
- Department of Radiation Oncology, CyberKnife Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, People's Republic of China
| | - Ping Wang
- Department of Radiation Oncology, CyberKnife Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, People's Republic of China
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Duffaud F, Ray-Coquard I, Salas S, Pautier P. Recent advances in understanding and managing leiomyosarcomas. F1000PRIME REPORTS 2015; 7:55. [PMID: 26097728 PMCID: PMC4447031 DOI: 10.12703/p7-55] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Leiomyosarcomas are malignant mesenchymal tumours that derive from the smooth muscle lineage. They are studied and frequently treated as if they are the same as other soft tissue sarcomas. Recent developments suggest that a different approach may be more appropriate. Their underlying genetic mechanisms remain unclear, and complex. Unbalanced karyotypic defects are the only shared features observed across different leiomyosarcoma subtypes. Unlike other soft tissue sarcomas, leiomyosarcomas are particularly sensitive to the combination of gemcitabine and docetaxel. Furthermore, treatment with trabectedin has shown a good efficacy in leiomyosarcomas, mainly in the form of chronic disease stabilisation.
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Affiliation(s)
- Florence Duffaud
- Aix Marseille Université (AMU), Service d'Oncologie médicaleCHU la Timone Boulevard J Moulin 13005 MarseilleFrance
| | - Isabelle Ray-Coquard
- Université Claude Bernard Lyon I, Oncologie Médicale, Centre Leon Bérard28 rue Laennec, 69008 LyonFrance
| | - Sébastien Salas
- Aix Marseille Université (AMU), Service d'Oncologie médicaleCHU la Timone Boulevard J Moulin 13005 MarseilleFrance
| | - Patricia Pautier
- Gustave Roussy Cancer Campus114 Rue E Vaillant, 94805 VillejuifFrance
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9
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Bojahr B, De Wilde RL, Tchartchian G. Malignancy rate of 10,731 uteri morcellated during laparoscopic supracervical hysterectomy (LASH). Arch Gynecol Obstet 2015; 292:665-72. [PMID: 25820974 PMCID: PMC4529878 DOI: 10.1007/s00404-015-3696-z] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 03/20/2015] [Indexed: 01/29/2023]
Abstract
Purpose This study aims to evaluate the number of cases of occult uterine malignancies in all LASH surgeries at the MIC clinic (Berlin) and to verify how the operative technique affects the prognosis of the disease. Methods Data of 10,731 patients who underwent a standardized LASH surgery with electric power morcellation between 1998 and April 30, 2014 were retrospectively analyzed. Main indication for LASH was symptomatic uterine myomas (81.3 %). Results No intra-operative complication was caused by use of a morcellator. In total, six sarcomas (0.06 %), including four endometrial stromal sarcomas (0.04 %) two leiomyosarcomas (0.02 %), and eight endometrial cancers (0.07 %) were documented. This amounts to a very low uterine malignancy rate of 0.13 %. Median follow-up period for all six patients with sarcoma and seven patients with endometrial cancer was 65.58 months (13–169). No recurrence was reported for the patients with endometrial cancer and five sarcoma patients in the comprehensible follow-up period. One patient died 13 months after LASH surgery due to the diagnosed leiomyosarcoma with peritoneal carcinomatosis and bone metastases. Conclusion In 10,731 morcellated uteri during LASH only 0.06 % sarcoma and 0.07 % endometrial carcinoma were detected. All patients should be informed about the rare possibility of a malignant disease during pre-operative counseling. With a timely follow-up surgery according to the oncologic guidelines, our data suggest a very good prognosis in terms of survival after LASH with morcellation of malignant tumors in the uterus.
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Affiliation(s)
- Bernd Bojahr
- Klinik für Minimal Invasive Chirurgie, Kurstraße 11, 14129, Berlin-Zehlendorf, Germany,
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10
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Yu T, Kim HJ, Wu HG, Ha SW, Song YS, Park NH, Kim JW. Outcome analysis in patients with uterine sarcoma. Radiat Oncol J 2015; 33:29-35. [PMID: 25874175 PMCID: PMC4394066 DOI: 10.3857/roj.2015.33.1.29] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 01/23/2015] [Accepted: 02/10/2015] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To analyze the prognostic factors for survivals and to evaluate the impact of postoperative whole pelvic radiotherapy (WPRT) on pelvic failure in patients with uterine sarcoma treated with radical surgery. MATERIALS AND METHODS We retrospectively analyzed 75 patients with uterine sarcoma who underwent radical surgery with (n = 22) or without (n = 53) radiotherapy between 1990 and 2010. There were 23 and 52 patients with carcinosarcoma and non-carcinosarcoma (leiomyosarcoma, 22; endometrial stromal sarcoma, 25; others, 5), respectively. The median follow-up period was 64 months (range, 17 to 269 months). RESULTS The 5-year overall survival (OS) and pelvic failure-free survival (PFFS) of total patients was 64.2% and 83.4%, respectively. Multivariate analysis revealed that mitotic count (p = 0.006) was a significant predictor of OS. However, factors were not found to be associated with PFFS. On analyzing each of the histologic subtypes separately, postoperative WPRT significantly reduced pelvic failure in patients with carcinosarcoma (10.0% vs. 53.7%; p = 0.046), but not in patients with non-carcinosarcoma (12.5% vs. 9.9%; p = 0.866). Among the patients with carcinosarcoma, 4 patients (17%) had recurrence within the pelvis and 3 patients (13%) had recurrence in other sites as an initial failure, whereas among the patients with non-carcinosarcoma, 3 patients (6%) experienced pelvic failure and 13 patients (25%) experienced distant failure. CONCLUSION The most significant predictor of OS was mitotic count. Based on the improved PFFS after postoperative WPRT only in patients with carcinosarcoma and the difference in patterns of failure between histologic subtypes, optimal adjuvant treatment options should be offered to patients based on the risk of recurrence patterns.
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Affiliation(s)
- Tosol Yu
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Hak Jae Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Hong-Gyun Wu
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Whan Ha
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Yong-Sang Song
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Noh-Hyun Park
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Jae-Won Kim
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
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11
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High-Grade Undifferentiated Sarcomas of the Uterus: Diagnosis, Outcomes, and New Treatment Approaches. Curr Oncol Rep 2014; 16:405. [DOI: 10.1007/s11912-014-0405-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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12
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Cormio G, Loizzi V, Ceci O, Leone L, Selvaggi L, Bettocchi S. Unsuspected diagnosis of uterine leiomyosarcoma after laparoscopic myomectomy. J OBSTET GYNAECOL 2014; 35:211-2. [PMID: 25057886 DOI: 10.3109/01443615.2014.937332] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- G Cormio
- Department of Biomedical Science and Human Oncology, Obstetrics and Gynecology Unit
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13
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Caractéristiques clinicopathologiques et facteurs pronostiques des sarcomes utérins dans le centre tunisien. Bull Cancer 2014; 101:669-80. [DOI: 10.1684/bdc.2014.1921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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14
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Jain S, Mahajan S, Srivastava M. Pure chondrosarcomas of the uterus: a rare uterine tumour. J OBSTET GYNAECOL 2014; 34:752-4. [PMID: 24921947 DOI: 10.3109/01443615.2014.923820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- S Jain
- Department of Pathology, Sir Ganga Ram Hospital , New Delhi , India
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15
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Hormonal treatment in recurrent and metastatic gynaecological cancers: a review of the current literature. Curr Oncol Rep 2014; 15:541-8. [PMID: 24097282 DOI: 10.1007/s11912-013-0343-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
For many years hormonal treatment has played a role in the treatment of a selected group of patients with a variety of recurrent or metastatic gynaecological cancers, including ovarian and endometrial carcinomas, endometrial stromal sarcomas and granulosa cell tumours. Hormonal agents that are typically used include luteinizing-hormone-releasing hormone analogues, progestogens, selective oestrogen-receptor-modulating drugs such as tamoxifen, and more recently aromatase inhibitors. The rates of response to these drugs differ considerably depending on the tumour type, disease grade and stage as well as the type of drug used. Patients with granulosa cell tumours and endometrial stromal sarcomas have the highest response rates; owing to the rarity of these tumour types, the documented response rates are based on case reports and small series. Response rates in patients with recurrent and metastatic endometrial and ovarian carcinoma have been lower. It has been suggested that patients with well-differentiated and hormone-receptor-positive carcinomas are more likely to benefit from hormonal treatment. However, the data to support this are limited, and at times conflicting, with very few prospective studies to date. This review updates the evidence for the use of hormonal treatment in patients with potentially hormone responsive recurrent and metastatic gynaecological cancers.
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16
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Dong R, Pang Y, Mao H, Yang N, Liu P. Successful pregnancy following conservative management of low-grade endometrial stromal sarcoma: A case report. Oncol Lett 2014; 7:1039-1042. [PMID: 24944665 PMCID: PMC3961328 DOI: 10.3892/ol.2014.1858] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 12/23/2013] [Indexed: 01/04/2023] Open
Abstract
It is uncommon that fertility is preserved in young nulliparous females with low-grade endometrial stromal sarcoma (ESS). Therefore, successful pregnancy following such conservative management has been rarely reported in previous literature. A 25-year-old female (gravida, 0; para, 0) underwent hysteroscopic surgery and was pathologically diagnosed with an endometrial stromal nodule. The patient underwent fertility-preserving local resection and uterine reconstruction, with a final pathological diagnosis of low-grade ESS. Endocrine therapy was then administered. Conservative management resulted in the complete remission of low-grade ESS. The patient naturally conceived and successfully delivered a healthy baby at 42 weeks' gestation by cesarean section, ~30 months following diagnosis with low-grade ESS. In conclusion, conservative management, including fertility-preserving local mass resection and endocrine therapy, can be effective for low-grade ESS and may yield a favorable outcome for young nulliparous females desiring fertility preservation.
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Affiliation(s)
- Ruiying Dong
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Yingxin Pang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Hongluan Mao
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Ning Yang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Peishu Liu
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
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17
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Uterine sarcoma-current management and experience from a regional cancer centre in North India. Arch Gynecol Obstet 2013; 288:873-82. [DOI: 10.1007/s00404-013-2843-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 04/03/2013] [Indexed: 11/25/2022]
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18
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Huang CY, Chen CA, Chen YL, Chiang CJ, Hsu TH, Lin MC, Lai MS, Chen CJ, You SL, Cheng WF. Nationwide surveillance in uterine cancer: survival analysis and the importance of birth cohort: 30-year population-based registry in Taiwan. PLoS One 2012; 7:e51372. [PMID: 23251510 PMCID: PMC3519542 DOI: 10.1371/journal.pone.0051372] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2012] [Accepted: 11/05/2012] [Indexed: 12/28/2022] Open
Abstract
Introduction Uterine cancer was the most rapidly increasing malignancy and the second most common gynecologic malignancy in Taiwan. Methods We analyzed the secular trend of uterine cancer incidence and compare the survival of women with uterine carcinomas and uterine sarcomas in Taiwan. Data on women diagnosed with uterine cancer between 1979 and 2008 were obtained from the Taiwan cancer registry. Survival data were analyzed by using Kaplan-Meier and Cox proportional hazards regression methods. Results Records of 11,558 women with uterine carcinomas and 1,226 women with uterine sarcomas were analyzed. The age-adjusted incidence rate of endometrioid adenocarcinoma increased from 0.83 per 100,000 women per year between 1979 and 1983 to 7.50 per 100,000 women per year between 2004 and 2008. The 5-year survival rate of women with endometrioid adenocarcinoma (83.2%) was higher than that for women with clear cell carcinoma (58.3%), serous carcinoma (54.4%), and carcinosarcoma (35.2%) (p<0.0001, log-rank test). The 5-year survival rates of women with low grade endometrial stromal sarcoma, endometrial stromal sarcoma, leiomyosarcoma (LMS), and adenosarcoma were 97.5%, 73.5%, 60.1%, and 77.2%, respectively (p<0.0001, log rank test). The histologic type of endometrioid adenocarcinoma, young age, and treatment period after 2000 were independent, favorable prognostic factors in women with uterine carcinomas by multivariate analysis. The histologic type of LMS, old age, and treatment period after 2000 were independent, poor prognostic factors in women with uterine sarcomas by multivariate analysis. Conclusions An increase over time in the number of patients with endometrioid adenocarcinomas was noted in this 30-year, nationwide, population-based study. Histologic type, age and treatment period were survival factors for uterine cancers. A more comprehensive assessment of uterine cancers and patient care should be undertaken on this increasingly common type of cancer.
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Affiliation(s)
- Chia-Yen Huang
- Gynecologic Cancer Center, Cathay General Hospital, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chi-An Chen
- Department of Obstetrics and Gynecology, National Taiwan University, Taipei, Taiwan
| | - Yu-Li Chen
- Gynecologic Cancer Center, Cathay General Hospital, Taipei, Taiwan
| | - Chun-Ju Chiang
- Graduate Institute of Epidemiology, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Tsui-Hsia Hsu
- Bureau of Health Promotion, Department of Health, Executive Yuan, Taipei, Taiwan
| | - Ming-Chieh Lin
- Department of Pathology, National Taiwan University, Taipei, Taiwan
| | - Mei-Shu Lai
- Graduate Institute of Epidemiology, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chien-Jen Chen
- Graduate Institute of Epidemiology, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - San-Lin You
- Institute of Life Sciences, School of Public Health, National Defense Medical Center, Taipei, Taiwan
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
- * E-mail: (SLY); (WFC)
| | - Wen-Fang Cheng
- Department of Obstetrics and Gynecology, National Taiwan University, Taipei, Taiwan
- Graduate Institute of Oncology, National Taiwan University, Taipei, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- * E-mail: (SLY); (WFC)
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19
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Thomakos N, Rodolakis A, Zagouri F, Zacharakis D, Sotiropoulou M, Akrivos N, Haidopoulos D, Papadimitriou CA, Dimopoulos MA, Antsaklis A. Serum CA 125, CA 15-3, CEA, and CA 19-9: a prognostic factor for uterine carcinosarcomas? Arch Gynecol Obstet 2012; 287:97-102. [PMID: 22941327 DOI: 10.1007/s00404-012-2529-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Accepted: 08/13/2012] [Indexed: 12/14/2022]
Abstract
PURPOSE There is a controversy in the literature regarding the role and the prognostic significance of serum markers in uterine carcinosarcomas (CSs). We attempted to determine the utility of serum CA 125, CA 15-3, CA 19-9, and CEA as prognostic factors and disease follow-up in patients with CS of the uterus. METHODS Thirty-seven patients with CS of the uterus were included in this study. Information regarding demographic, clinical, pathologic, tumor marker data (CA 125, CA 19-9, CA 15-3, and CEA both pre- and postoperatively) treatment and outcome information was obtained, followed by Statistical analysis. RESULTS The mean follow-up period was 3.5 years. None of the study serum markers showed significant association with the outcome. Greater hazard was found for cases that staged from IIIA to IV compared to those staged from IA to IIB (HR = 4.75, 95 % CI: 1.99-11.3). Also, greater hazard was found for adenosquamous histological type compared to the other histological types. When multiple Cox regression analysis with stepwise approach was implied, it indicated stage as the only significant factor for the outcome. Elevated CA19-9 was more frequent in cases with heterologous sarcoma (p = 0.036). CONCLUSION In this retrospective study, none of the preoperative serum tumor markers, neither epithelial component, histological type, nor grade showed a significant association with prognosis. This null finding may have significant implications in the common clinical practice; given that there is a controversy in the literature regarding the role and the significance of the prognostic significance of serum CEA, CA 125, CA 19-9, and CA 15-3.
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Affiliation(s)
- Nikolaos Thomakos
- Department of Obstetrics and Gynecology, Alexandra Hospital, School of Medicine, University of Athens, Athens, Greece
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20
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Durnali A, Tokluoglu S, Ozdemir N, Inanc M, Alkis N, Zengin N, Sonmez OU, Kucukoner M, Anatolian Society of Medical Oncology (ASMO) ASOMO(ASMO. Prognostic Factors and Treatment Outcomes in 93 Patients with Uterine Sarcoma from 4 Centers in Turkey. Asian Pac J Cancer Prev 2012; 13:1935-41. [DOI: 10.7314/apjcp.2012.13.5.1935] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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21
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Efficacy and safety of imatinib mesylate (Gleevec®) and immunohistochemical expression of c-Kit and PDGFR-β in a Gynecologic Oncology Group Phase Il Trial in women with recurrent or persistent carcinosarcomas of the uterus. Gynecol Oncol 2010; 117:248-54. [DOI: 10.1016/j.ygyno.2010.01.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2009] [Revised: 12/28/2009] [Accepted: 01/04/2010] [Indexed: 11/23/2022]
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22
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The Role of Adjuvant Radiation in Uterine Sarcomas. Int J Radiat Oncol Biol Phys 2010; 76:728-34. [DOI: 10.1016/j.ijrobp.2009.02.077] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2008] [Revised: 01/30/2009] [Accepted: 02/25/2009] [Indexed: 11/22/2022]
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23
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How to deal with prognostic factors and radiotherapy results in uterine neoplasms with a sarcomatous component? Clin Transl Oncol 2009; 11:681-7. [DOI: 10.1007/s12094-009-0424-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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24
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Tzakas E, Liu S, Todd RW, Redman CW. Hormonal therapy with letrozole prior to surgical management of recurrent metastatic low-grade endometrial stromal sarcoma (LGESS). J OBSTET GYNAECOL 2009; 29:778-9. [DOI: 10.3109/01443610903165552] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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25
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Benito V, Lubrano A, Arencibia O, Andújar M, Alvarez E, Medina N, Falcón JM, Falcón O. Clinicopathologic analysis of uterine sarcomas from a single institution in the Canary Islands. Int J Gynaecol Obstet 2009; 107:44-9. [PMID: 19555952 DOI: 10.1016/j.ijgo.2009.05.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Revised: 04/14/2009] [Accepted: 05/20/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To evaluate the clinicopathologic data and prognostic factors for patients with uterine sarcomas treated at a single institution, with special emphasis on malignant mixed müllerian tumors (MMMT). METHODS Medical and anatomic pathology records were reviewed. Survival rates were analyzed using the Kaplan-Meier method. RESULTS The study included 89 patients: 48.4% with MMMT; 22.4% with leiomyosarcomas; 20.2% with endometrial stromal sarcomas; and 9% with adenosarcomas. FIGO stages I, II, III, and IV were identified in 57.3%, 9.0%, 22.5%, and 7.8% of patients respectively. Event-free survival rates after 2, 5, and 10 years were 70%, 61%, and 55% respectively, with a median time of 90 months (95% CI, 41-140 months). Overall survival rates after 2, 5, and 10 years were 50%, 45%, and 39% respectively, with a median time of 43 months (95% CI, 3-83 months). Multivariate analysis showed that stage, histology, tumor size, and parity had an independent influence on overall survival. CONCLUSIONS MMMT are the most aggressive tumors and their behavior strongly resembles that of high-grade endometrial adenocarcinoma. Prognostic factors affecting survival were stage, histology, tumor size, and parity.
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Affiliation(s)
- Virginia Benito
- Gynecologic Oncology Department, University Hospital of Canary Islands, Avda. Marítima del Sur s/n, Las Palmas de Gran Canaria, Spain.
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Zagouri F, Dimopoulos AM, Fotiou S, Kouloulias V, Papadimitriou CA. Treatment of early uterine sarcomas: disentangling adjuvant modalities. World J Surg Oncol 2009; 7:38. [PMID: 19356236 PMCID: PMC2674046 DOI: 10.1186/1477-7819-7-38] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2008] [Accepted: 04/08/2009] [Indexed: 11/10/2022] Open
Abstract
Uterine sarcomas are a rare group of neoplasms with aggressive clinical course and poor prognosis. They are classified into four main histological subtypes in order of decreasing incidence: carcinosarcomas, leiomyosarcomas, endometrial stromal sarcomas and "other" sarcomas. The pathological subtype demands a tailored approach. Surgical resection is regarded as the mainstay of treatment. Total abdominal hysterectomy and bilateral salpingo-oophorectomy represents the standard treatment of uterine sarcomas. Pelvic and para-aortic lymph node dissection in carcinosarcomas is recommended, given their high incidence of lymph node metastases, and may have a role in endometrial stromal sarcomas. Adjuvant radiation therapy has historically been of little survival value, but it appears to improve local control and may delay recurrence. Regarding adjuvant chemotherapy, there is little evidence in the literature supporting its use except for carcinosarcomas. However, more trials are needed to address these issues, especially, their sequential application. Patients with uterine sarcomas should be referred to large academic centers for participation in clinical trials.
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Affiliation(s)
- Flora Zagouri
- Department of Clinical Therapeutics, Alexandra Hospital, University of Athens, School of Medicine, Athens, Greece.
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27
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Hoskins PJ, Le N. Preoperative tumor markers at diagnosis in women with malignant mixed müllerian tumors/carcinosarcoma of the uterus. Int J Gynecol Cancer 2008; 18:1200-1. [DOI: 10.1111/j.1525-1438.2007.01187.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
CA125 is a well-recognized marker for endometrial cancer. Uterine malignant mixed müllerian tumors (MMMTs) are increasingly being recognized as an aggressive adenocarcinoma, not a sarcoma. There are no data in the literature regarding CA125 in this malignancy. One hundred twelve women with surgically staged MMMT, diagnosed between July 1990 and September 2005, had a retrospective chart review performed. Preoperative CA125 levels were available in 29 (26%) women. Seventeen (49%) women had levels above the upper limit of normal of 35 kμ/L. Mean levels increased with increasing surgical stage: stage I 53.4 kμ/L; stage II 122.5 kμ/L; stage III 147.1 kμ/L; and stage IV 428.4 kμ/L. Elevated levels of CA19-9, CEA, and CA15-3 were found in 8%, 12%, and 25%, respectively.
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28
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Leung F, Assad F, Aouar Z, Hassan F, Le Guillouzic Y, Riethmuller D. [The diagnostic problem of uterine sarcomas: report on a case of carcinosarcoma mimicking a gastro-intestinal disease]. JOURNAL DE GYNECOLOGIE, OBSTETRIQUE ET BIOLOGIE DE LA REPRODUCTION 2008; 37:419-421. [PMID: 18407437 DOI: 10.1016/j.jgyn.2008.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2007] [Revised: 02/23/2008] [Accepted: 03/03/2008] [Indexed: 05/26/2023]
Abstract
Uterine sarcomas are rare tumours with poor prognosis. The most common presenting symptoms are vaginal bleeding or pelvic pain. We present a case of uterine carcinosarcoma diagnosed retrospectively after surgical specimen analysis in a 69-year-old patient presenting gastro-intestinal complaints. At the time of diagnosis, the patient was in FIGO, stage IV.
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Affiliation(s)
- F Leung
- Service de gynécologie-obstétrique, 2, place Saint-Jacques, CHU de Besançon, France.
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29
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Leung F, Terzibachian JJ, Aouar Z, Govyadovskiy A, Lassabe C. Sarcomes utérins : aspects cliniques et histopathologiques. À propos de 15 cas. ACTA ACUST UNITED AC 2008; 36:628-35. [DOI: 10.1016/j.gyobfe.2008.03.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2007] [Accepted: 03/21/2008] [Indexed: 12/31/2022]
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30
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Park JY, Kim DY, Suh DS, Kim JH, Kim YM, Kim YT, Nam JH. Prognostic factors and treatment outcomes of patients with uterine sarcoma: analysis of 127 patients at a single institution, 1989-2007. J Cancer Res Clin Oncol 2008; 134:1277-87. [PMID: 18506484 DOI: 10.1007/s00432-008-0422-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2008] [Accepted: 05/13/2008] [Indexed: 01/15/2023]
Abstract
PURPOSE Uterine sarcoma is a rare malignancy with the worst prognosis of all uterine cancers. This study evaluated the prognostic factors and treatment outcomes of patients with this disease. METHODS A retrospective analysis was performed on 127 patients with histologically verified uterine sarcoma who were treated and followed at the Asan Medical Center (Seoul, Korea) from 1989 to 2007. RESULTS Histological analyses revealed that 37 patients had endometrial stromal sarcoma, 44 had malignant mixed mullerian tumors and 46 had leiomyosarcoma. Surgical stages, as defined by the International Federation of Gynecology and Obstetrics (FIGO) system, were I in 82 patients, II in 6 patients, III in 18 patients and IV in 19 patients. All patients underwent surgical treatment and 72 patients received adjuvant therapy. The 10-year disease-free survival (DFS) rate was 30% and the 10-year overall survival (OS) rate was 48%, with a mean follow-up time of 38 months (ranging from 1 to 212 months). Adjuvant radiation and chemotherapy had limited impact on the outcome of early-stage disease. However, patients with advanced-stage disease who received adjuvant chemotherapy had significantly longer OS times. A multivariate analysis revealed that FIGO stage (P = 0.025), depth of myometrial invasion (P = 0.004), and complete cytoreduction (P = 0.030) were significantly associated with DFS, while menopausal status (P = 0.044), FIGO stage (P = 0.016), depth of myometrial invasion (P = 0.029), and lymph-vascular space invasion (LVSI) (P = 0.020) were significantly associated with OS. CONCLUSIONS This study suggests that complete cytoreduction is important and adjuvant chemotherapy can help achieve favorable prognoses in patients with advanced stage disease. However, postmenopausal status, advanced FIGO stage, deep myometrial invasion, and positive LVSI were associated with poor prognosis.
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Affiliation(s)
- Jeong-Yeol Park
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, #388-1 Poongnap-2 dong, Songpa-gu, Seoul 138-736, South Korea
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Hysteroscopic Resection of Uterine Leiomyosarcoma: A Case Report and Literature Review. J Minim Invasive Gynecol 2008; 15:380-3. [DOI: 10.1016/j.jmig.2008.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2007] [Revised: 01/31/2008] [Accepted: 02/08/2008] [Indexed: 11/24/2022]
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32
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Chondrosarcoma of the uterus: case report and literature review. Arch Gynecol Obstet 2008; 278:369-72. [DOI: 10.1007/s00404-008-0595-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2007] [Accepted: 02/04/2008] [Indexed: 10/22/2022]
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Li N, Wu LY, Zhang HT, An JS, Li XG, Ma SK. Treatment options in stage I endometrial stromal sarcoma: A retrospective analysis of 53 cases. Gynecol Oncol 2008; 108:306-11. [DOI: 10.1016/j.ygyno.2007.10.023] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2007] [Revised: 10/19/2007] [Accepted: 10/19/2007] [Indexed: 10/22/2022]
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34
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Engin H. High-grade endometrial stromal sarcoma following tamoxifen treatment. Gynecol Oncol 2007; 108:253-4. [PMID: 17928038 DOI: 10.1016/j.ygyno.2007.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2007] [Accepted: 09/04/2007] [Indexed: 10/22/2022]
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35
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Denschlag D, Masoud I, Stanimir G, Gilbert L. Prognostic factors and outcome in women with uterine sarcoma. Eur J Surg Oncol 2006; 33:91-5. [PMID: 17174517 DOI: 10.1016/j.ejso.2006.11.012] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2006] [Accepted: 11/09/2006] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES A retrospective analysis of patients with uterine sarcoma was undertaken to assess prognostic factors and treatment related outcomes. PATIENTS AND METHODS Ninety-four patients (median age: 60years, range: 20-93years) with a histologically verified uterine sarcoma treated at the McGill University Health Centre (MUHC) between 1989 and 2004 were identified from the tumor registry and pathology database. RESULTS Twenty-eight patients had an endometrial stromal sarcoma (ESS), 30 had a leiomyosarcoma (LMS), and 36 had mixed muellerian tumors (MMT). According to FIGO classification, Stage I, II, III, and IV tumors were identified in 49, 7, 20, and 18 patients, respectively. At the time of analysis, 55.5% of patients (52/94) were dead due to progressive sarcoma disease; 8.5% of the patients (8/94) were alive with disease recurrence, and 36.2% (34/94) were alive without disease recurrence, with a median survival of 35months. Univariate analysis demonstrated a statistically significant association between overall survival and histology in favor of patients with ESS (p<0.001). Analyzing each of the histological subtypes separately, adjuvant treatment with chemotherapy and/or hormonal treatment had no demonstrable impact on overall survival. In multivariate analysis age and advanced stage, remained a significant predictor for overall survival in patients with LMS and MMT, but not in patients with ESS. Regarding adjuvant treatment, radiotherapy had a significant impact on overall survival only in patients with MMT (p=0.002). CONCLUSIONS In patients with uterine sarcoma, in comparison to LMS and MMT, ESS tends to present as a less aggressive disease with a favorable outcome. Furthermore, reflected by an improved overall survival after radiotherapy only in patients with MMT, it seems to be mandatory to differentiate between these histological subtypes.
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Affiliation(s)
- D Denschlag
- Division of Gynecological Oncology, Department of Obstetrics and Gynecology, Royal Victoria Hospital, 687 Pine Avenue West, Women's Pavillion, F9.26, McGill University, Montreal, Quebec H3A 1A1, Canada.
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Maltaris T, Boehm D, Dittrich R, Seufert R, Koelbl H. Reproduction beyond cancer: A message of hope for young women. Gynecol Oncol 2006; 103:1109-21. [PMID: 16996582 DOI: 10.1016/j.ygyno.2006.08.003] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2006] [Revised: 07/19/2006] [Accepted: 08/04/2006] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Aggressive chemotherapy and radiotherapy or radical oncological surgery in young women with cancer has greatly enhanced these patients' life expectancy, but these treatments often cause infertility or premature ovarian failure due to a massive destruction of the ovarian reserve. The objective of this review is to discuss the effect of the various cancer treatments on fertility and present the various fertility sparing operations and fertility preservation strategies. METHOD An extensive survey of the most up-to-date literature was performed. RESULTS This review discusses the impact of current cancer treatment on fertility potential and the various surgical and assisted-reproduction innovations available today for the most common cancers in young women. Although the ability to retain reproductive potential is becoming a major quality-of-life factor in an increasing number of young female cancer survivors, they are still being poorly counseled with regard to the negative impact of the treatment on their fertility and on their options for fertility preservation. CONCLUSION As the emerging discipline of fertility preservation is steadily attracting increasing interest, developments in the near future promise to be very exciting. However, in everyday routine work, better interdisciplinary cooperation between gynecological and pediatric oncologists, surgeons, immunologists, and endocrinologists is necessary so that individualized options for fertility preservation can be offered in advance of surgical procedures or cancer treatments.
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Affiliation(s)
- Theodoros Maltaris
- Department of Obstetrics and Gynecology, Johannes Gutenberg University, Mainz University Hospital, Langenbeckstrasse 1, 55124 Mainz, Germany.
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Kim SH, Kim JW, Kim YT, Kim JH, Yoon BS, Ryu HS. Prognostic factors and expression of p53 and mdm-2 in uterine sarcomas. Int J Gynaecol Obstet 2006; 95:272-7. [PMID: 16930603 DOI: 10.1016/j.ijgo.2006.03.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2005] [Revised: 03/11/2006] [Accepted: 03/15/2006] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To evaluate the clinicopathologic prognostic factors of uterine sarcoma, and determine whether overexpression of p53 and mdm-2 proteins correlate with overall survival and prognostic factors. METHODS Thirty specimens from 43 patients with uterine sarcoma were available for slide review and evaluated by immunohistochemistry at Yonsei and Ajou University Medical Centers for the expression of p53 and mdm-2. RESULTS Overall survival was found to correlate to histologic type of uterine sarcoma, surgical stage, tumor grade, and mitotic index. Whereas 63% of the sarcomas expressed p53, with a significant correlation to overall survival, 60% expressed mdm-2, with a significant correlation to the mitotic index but not to overall survival. CONCLUSION Histologic type, surgical stage, tumor grade, mitotic index, and p53 expression were prognostic factors of the overall survival of patients with uterine sarcoma.
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Affiliation(s)
- S H Kim
- Department of Obstetrics and Gynecology, Women's Cancer Clinic, Institute of Women's Life Science, Yonsei University College of Medicine, Seoul, South Korea
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Hassini A, Khemiri B, Sfar E, Chelly D, Chennoufi MB, Chelly H. Sarcomes utérins : aspects cliniques et thérapeutiques. ACTA ACUST UNITED AC 2006; 35:348-55. [PMID: 16940904 DOI: 10.1016/s0368-2315(06)76407-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE Uterine sarcomas are rare tumours characterized by clinical and histopathological diversity and poor prognosis. We analyzed diagnostic, prognostic and therapeutic difficulties encountered with these tumors by insisting on the importance of early diagnosis. PATIENTS AND METHODS From 1997 to 2004 ten patients with uterine sarcoma who underwent surgery in the obstetrics and gynecology unit at the Tunis maternity center were included in this retrospective study. The tumors were classified at the time of diagnosis using the FIGO staging system. The histological diagnosis was based on the WHO classification. RESULTS There were 5 cases of leiomyosarcoma, 2 cases of carcinosarcoma, 2 cases of endometrial stromal sarcoma and 1 adenosarcoma. There were four cases of stage I, two cases of stage II, two cases of stage III and two of stage IV tumors. The diagnosis of uterine sarcoma was strongly suspected and proved before the initial operation in 20% of cases and during this operation in 60% of cases. Diagnosis was only established at the histological exam in two cases. Total hysterectomy with bilateral salpingo-oophorectomy was performed in 90% of patients. Radiation therapy was performed in four. Chemotherapy was delivered in two patients. After an average of four years five patients were in remission, three had died and two were lost to follow-up. CONCLUSION Early preoperative or intra-operative diagnosis is essential while awaiting for more effective chemotherapy protocols or therapeutic strategies.
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Affiliation(s)
- A Hassini
- Service A de Gynécologie Obstétrique, Centre de Maternité et de Néonatologie de Tunis, Tunisie
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Kelly KLJ, Craighead PS. Characteristics and management of uterine sarcoma patients treated at the Tom Baker Cancer Centre. Int J Gynecol Cancer 2005; 15:132-9. [PMID: 15670308 DOI: 10.1111/j.1048-891x.2005.15014.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
The purpose of this study was to evaluate patients with uterine sarcoma from Southern Alberta to assess patterns of care and outcomes associated with treatment by a multidisciplinary team. Using the Alberta Cancer Registry database, charts of all uterine sarcoma patients treated between 1988 and 1997 in Southern Alberta were extracted. The majority of patients underwent definitive surgery. Adjuvant treatments were performed in selected patients at the discretion of the multidisciplinary tumor board. Demographics, management, and outcomes were collected into an electronic database. Eighty-seven patients were treated for uterine sarcoma at the Tom Baker Cancer Centre from 1988 to 1997. The 5-year overall survival rate was 48% and the 10-year overall survival rate was 21%. Univariate analysis demonstrated that stage, histologic subtype, and treatment with radiation therapy had a significant effect on local control and that stage and histologic subtype had a significant effect on survival. Stage was significant in the multivariate analysis for both local control (P = 0.008) and overall survival (P = 0.0001). Based on the findings in this series, stage remains a significant prognostic factor for patients with uterine sarcoma. Multidisciplinary care in the local setting reduced the use of adjuvant therapy without impacting adversely on survival or local control.
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Affiliation(s)
- K-L J Kelly
- Department of Radiation Oncology, Tom Baker Cancer Centre, 1331-29 Street NW, Calgary, Alberta T2N 4N2, Canada.
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Dushkin H, Schilder RJ. Imatinib mesylate and its potential implications for gynecologic cancers. Curr Treat Options Oncol 2005; 6:115-20. [PMID: 15717993 DOI: 10.1007/s11864-005-0019-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Among gynecologic malignancies, ovarian carcinoma is the most frequent cause of death, with the majority of patients presenting at advanced stage. There is a high rate of recurrence despite first-line chemotherapy. Sarcoma of the uterus, while accounting for a small percent of uterine cancers, is also associated with a high-recurrence rate and poor overall survival. Therefore, the development of novel treatment strategies is paramount. Imatinib mesylate (Gleevec; Novartis Pharmaceuticals Corp., East Hanover, NJ) is a tyrosine kinase inhibitor with activity against abl, c-kit, and platelet derived growth factor receptor (PDGFR), and is approved for the treatment of chronic myelogenous leukemia and gastrointestinal stromal tumor. Preclinical data provides evidence for c-kit and PDGFR expression in ovarian epithelial carcinomas and uterine sarcomas and have led to clinical trials evaluating the use of imatinib in these malignancies. Additionally, inhibition of PDGFR signaling has been proposed as an effective mechanism of chemotherapy by lowering tumor interstitial fluid pressure. Recent data have also suggested benefit with metronomic scheduling of cytotoxic agents at lower doses at more frequent dosing intervals, in combination with other targeted therapies. While activity of this agent remains to be established, further studies of imatinib in gynecologic malignancies are warranted, to demonstrate not only single-agent activity and the enhancement of cytotoxicity of other antineoplastic agents.
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Affiliation(s)
- Holly Dushkin
- Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111, USA
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Aviram R, Ochshorn Y, Markovitch O, Fishman A, Cohen I, Altaras MM, Tepper R. Uterine sarcomas versus leiomyomas: gray-scale and Doppler sonographic findings. JOURNAL OF CLINICAL ULTRASOUND : JCU 2005; 33:10-13. [PMID: 15690441 DOI: 10.1002/jcu.20075] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
PURPOSE The aim of the study was to evaluate the contribution of gray-scale sonography and Doppler flow studies in differentiating between uterine sarcomas of different histologic types and leiomyomas. PATIENTS AND METHODS The study included 111 patients, divided retrospectively into 2 groups: 98 patients with leiomyomas and 13 with postoperative diagnosis of uterine sarcoma. This latter group was further divided into a group of 6 patients with uterine leiomyosarcoma and 7 with malignant mixed mesodermal tumor. The gray-scale sonograms and Doppler parameters in the 3 groups were compared. RESULTS The patients with leiomyomas were younger than those with sarcomas (52 years +/- 11 versus 65 years +/- 15, p < 0.05). No differences were noted between the 3 groups regarding gravidity, parity, symptoms upon admission, or findings during physical examination. The sonographic appearances of the leiomyomas were similar to those of the leiomyosarcomas, but in 6/7 cases, they were different from those of the malignant mixed mesodermal tumors. There was a significant difference between the mean resistance index in arterioles of the leiomyomas (0.59 +/- 0.01) and that of the malignant mixed mesodermal tumors (0.41 +/- 0.06) (P < 0.001) but not between those of the leiomyomas and the leiomyosarcomas (0.49 +/- 0.18). CONCLUSIONS Doppler flow studies may assist in differentiating between leiomyomas and malignant mixed mesodermal tumors but not between leiomyomas and leiomyosarcomas.
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Affiliation(s)
- Rami Aviram
- Ultrasound Unit, Department of Obstetrics and Gynecology, Sapir Medical Center, Kfar Saba, 44281, Israel
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Livi L, Andreopoulou E, Shah N, Paiar F, Blake P, Judson I, Harmer C. Treatment of uterine sarcoma at the Royal Marsden Hospital from 1974 to 1998. Clin Oncol (R Coll Radiol) 2004; 16:261-8. [PMID: 15214650 DOI: 10.1016/j.clon.2004.01.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
AIMS Uterine sarcomas are rare tumours with histopathological diversity characterised by rapid clinical progression and poor prognosis. Optimal management consists of complete surgical removal, but is not clear whether adjuvant radiotherapy improves the prognosis. The aim of this retrospective study was to investigate the clinical and histopathological characteristics together with treatment and outcome of patients with uterine sarcomas. MATERIALS AND METHODS Records of 100 patients treated at the Royal Marsden Hospital between 1974-1998 were reviewed: 47 leiomyosarcoma (LMS), 30 mixed mullerian tumours (MMT), 19 endometrial stromal sarcoma (ESS), one haemangiopericytoma, one rhabdomyosarcoma and two unspecified sarcoma. There were 50, 11, 21 and 18 patients with stage I, II, III and IV carcinoma, respectively. Thirty-four patients had high-grade disease. Fifty-three patients received adjuvant radiotherapy. The median age was 55 years (range: 18-83 years). The median follow-up was 54 months (range: 3 months to 27 years). RESULTS The overall 3, 5 and 10-year survival rates were 39%, 30% and 20%, respectively. Survival was significantly related to stage (P = 0.002), grade (P = 0.003) and histological type (P = 0.04), but not to use of postoperative irradiation. At 3 years, the survival rate was 42% for LMS, 22% for MMT and 63% for ESS. Local recurrence rate, however, was significantly improved after adjuvant radiotherapy with dose higher than 50 Gy (P = 0.001). CONCLUSIONS Prognosis is dependent on histopathological sub-type, grade and tumour stage. Adjuvant radiotherapy decreases local recurrence rate, but without significant impact on survival.
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Affiliation(s)
- L Livi
- Radiotherapy Department, Florence University, Florence, Italy
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Odunsi K, Moneke V, Tammela J, Ghamande S, Seago P, Driscoll D, Marchetti D, Baker T, Lele S. Efficacy of adjuvant CYVADIC chemotherapy in early-stage uterine sarcomas: results of long-term follow-up. Int J Gynecol Cancer 2004; 14:659-64. [PMID: 15304162 DOI: 10.1111/j.1048-891x.2004.14420.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Data on adjuvant chemotherapy in early-stage uterine sarcomas are conflicting and most often based on small patient groups with relatively short duration of follow-up. Approximately 60% of patients present with stage I disease with an overall 5-year survival of 30-50% when treated with surgery alone. This study examines the efficacy and results of long-term follow-up of a multiagent chemotherapy regimen of cyclophosphamide, vincristine, doxorubicin, and dacarbazine (CYVADIC) as adjuvant treatment for patients with stage I uterine sarcoma. Between 1982 and 1999, 24 evaluable patients with completely staged uterine sarcomas received adjuvant multiagent chemotherapy with vincristine sulfate (1mg /m(2)) on days 1 and 4, doxorubicin (40 mg /m(2)) and cyclophosphamide (400 mg /m(2)) on day 2, and dacarbazine (200 mg /m(2)) on days 1 through 4 for a total of nine monthly cycles or until recurrence of disease was documented. Survival distributions were calculated by the Kaplan-Meier method, and statistical significance was determined with the log-rank test. Factors significant on univariate analysis were analyzed in a multivariate fashion using Cox proportional hazards model. The histologic distribution of patients was 46% leiomyosarcoma, 33% mixed mullerian tumors, 13% stromal sarcomas, 4% adenosarcomas, and 4% hemangiosarcoma. The patients received 206 of a planned 216 cycles of chemotherapy. The median follow-up of the patient population was 93 months (range 11-213 months). Eight patients (33%) developed recurrent disease. The median time to recurrence was 19 months (range 7-184 months). The estimated survival for the entire group was 88, 75, and 69% at 2, 5, and 15 years, respectively. Factors that did not affect survival included age, histology, and tumor grade. Four patients required dose reductions secondary to grade 2-3 toxicities (hematologic). Grade 1 neurotoxicity was observed in six patients (25%) and grade 2 neurotoxicity in one patient (4%). Adjuvant CYVADIC chemotherapy appears to be safe and well tolerated in patients with stage I uterine sarcomas. Our data provide information on the longest duration of follow-up ever reported and suggests that CYVADIC may have a potential role in the adjuvant treatment of early-stage uterine sarcoma.
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Affiliation(s)
- K Odunsi
- Department of Gynecological Oncology, State University of New York at Buffalo, Buffalo, NY, USA
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Livi L, Paiar F, Shah N, Blake P, Villanucci A, Amunni G, Barca R, Judson I, Lodge N, Meldolesi E, Simontacchi G, Piperno G, Galardi A, Scoccianti S, Biti GP, Harmer C. Uterine sarcoma: twenty-seven years of experience. Int J Radiat Oncol Biol Phys 2004; 57:1366-73. [PMID: 14630275 DOI: 10.1016/s0360-3016(03)00750-8] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE A correlation of treatment for uterine sarcoma with outcome, prognostic importance of pathology, and clinical parameters. PATIENTS AND METHODS One hundred forty-one patients (median age: 56 years, range: 19-85 years) with a histologically verified uterine sarcoma were identified from a database compiled at the Royal Marsden Hospital and the University of Florence between 1974 and 2001. Seventy-two patients had leiomyosarcoma, 42 had mixed müllerian tumors, 22 had endometrial stromal sarcoma, 1 hemangiopericytoma, 1 rhabdomyosarcoma, and 3 patients had unspecified sarcoma. According to FIGO classification, Stage I, II, III, and IV tumors were identified in 71, 13, 31, and 26 patients, respectively. RESULTS At the time of analysis, 73.7% of patients were dead, and 26.3% were alive with a median survival of 2 years from initial diagnosis. Univariate analysis for cause-specific survival demonstrated statistical significance for histology (p = 0.02), grade (p = 0.003), stage (p = 0.007), and age (p = 0.02). Multivariate analysis demonstrated significant prognostic values for stage (p = 0.02) and histology (p = 0.05) only. Postoperative radiotherapy with a total dose higher than 50 Gy seems to be significant (p = 0.001) in reducing local recurrence. CONCLUSIONS Our data favor treatment for Stages I, II, and III of uterine sarcoma with radical surgery plus radical dose irradiation comprising both external beam radiotherapy and brachytherapy.
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Affiliation(s)
- L Livi
- Department of Radiotherapy, University of Florence, Florence, Italy.
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El Husseiny G, Al Bareedy N, Mourad WA, Mohamed G, Shoukri M, Subhi J, Ezzat A. Prognostic factors and treatment modalities in uterine sarcoma. Am J Clin Oncol 2002; 25:256-60. [PMID: 12040283 DOI: 10.1097/00000421-200206000-00010] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The aim of this study was to identify the impact of various prognostic factors in the management of uterine sarcoma. Fifty-nine patients with uterine sarcoma were treated at King Faisal Specialist Hospital and Research Center between 1980 and 1997. Forty-three patients (73%) were treated by total abdominal hysterectomy and bilateral salpingo-oophorectomy, 7 (12%) total abdominal hysterectomy and bilateral salpingo-oophorectomy with sampling of pelvic lymph nodes, and 9 (15%) had biopsy only. Nine patients received adjuvant treatment; five had radiation therapy (XRT), two had chemotherapy, one had combined XRT and chemotherapy, and one received hormonal treatment. Leiomyosarcoma cases accounted for 42% of all the uterine sarcomas, carcinosarcoma cases for 34%, and endometrial stromal sarcoma (ESS) for 24%. Fifty (85%) patients had pathologic grade II and III tumor, with only 9 patients grade I. Twenty-seven patients (46%) were classified surgically as stage I, 7 (12%) as stage II, 17 (29%) as stage III, and 8 (13%) had stage IV tumor. Recurrences developed in 34 patients (71%). The 5- and 10-year overall actuarial survival for all patients was 42%, and the corresponding relapse-free survivals for those who achieved complete response after primary treatment (48 patients) were 27% and 20%. On the univariate analysis, grade I tumors (p = 0.04), ESS (p = 0.02), nonmetastatic stage (p = 0.05), and negative peritoneal cytology (p = 0.04) were associated with better overall survival. Factors associated
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Affiliation(s)
- G El Husseiny
- Department of Radiation Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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Rovirosa A, Ascaso C, Ordi J, Abellana R, Arenas M, Lejarcegui JA, Pahisa J, Puig-Tintoré LM, Mellado B, Armenteros B, Iglesias X, Biete A. Is vascular and lymphatic space invasion a main prognostic factor in uterine neoplasms with a sarcomatous component? A retrospective study of prognostic factors of 60 patients stratified by stages. Int J Radiat Oncol Biol Phys 2002; 52:1320-9. [PMID: 11955745 DOI: 10.1016/s0360-3016(01)02808-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Sarcomatous neoplasms of the uterine corpus are still a challenge in terms of obtaining prognostic factors and the most optimum complementary treatment to surgery. The most important prognostic factor is stage; relapses usually appear during the first 2 years, and most patients die within the first 3 years. We have performed a multivariate study of prognostic factors, stratifying patients by stage, to determine their impact on overall survival, disease-free survival, local relapse-free survival, and distant metastasis-free survival. Special emphasis has been given to vascular and lymphatic space invasion (VLSI). METHODS Sixty patients diagnosed with uterine neoplasms with a main sarcomatous component were treated at Hospital Clínic i Universitari of Barcelona between January 1975 and June 1999. Pathologic type: 32 carcinosarcomas, 14 leiomyosarcomas, 9 adenosarcomas, and 5 endometrial stromal sarcomas. TREATMENT 58/60 surgery, 35/60 postoperative radiotherapy, 2/60 exclusive chemotherapy, and 3/60 complementary chemotherapy. FIGO stages: 43 Stage I, 4 Stage II, 11 Stage III, and 2 Stage IV. Variables analyzed: age, stage, vascular and lymphatic space invasion, myometrial invasion, mitotic index, tumor size, unicentricity/multicentricity, necrosis, and radiotherapy. STATISTICS the S and Cox proportional risk models. The partial effect of each risk factor was calculated by hazard ratio (HR) with a confidence interval of 95%. RESULTS Early stages: Multivariate analysis showed that tumor size larger than 8 cm and VLSI had an impact on overall survival (HR = 4.01 and HR = 24.45, respectively). VLSI was present in 23% of the cases. Myometrial invasion greater than 50% had an impact on disease-free survival and local relapse-free survival (HR was 9.75 and 3.20, respectively). VLSI had an impact on distant metastasis-free survival (HR = 2.92). Advanced stages: VLSI was present in 89% of the cases. Only leiomyosarcoma type made the overall survival worse (HR = 10.54). CONCLUSIONS Vascular and lymphatic space invasion was a relevant prognostic factor in our series, with an impact on overall survival and distant metastasis-free survival in early stages. In advanced stages, VLSI had no impact on survival, but was present in 89% of cases. Myometrial invasion >50% had an impact on local relapse. Advanced stages had a more aggressive behavior, and there was a higher incidence of poor prognostic factors in these stages. Nevertheless, prospective studies are still needed on prognostic factors and on the best treatment option.
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Affiliation(s)
- Angeles Rovirosa
- Department of Radiation Oncology, Hospital Clínic i Universitari, Barcelona, Spain.
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Riddle PJ, Echeta CB, Manek S, Lavery BA, Charnock FML, Mackenzie I, Ganesan TS. Retrospective study of management of uterine sarcomas at Oxford 1990-1998: role of adjuvant treatment. Clin Oncol (R Coll Radiol) 2002; 14:54-61. [PMID: 11899904 DOI: 10.1053/clon.2001.0003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We report a retrospective study of 47 consecutive patients with uterine sarcoma treated at the Churchill Hospital in Oxford between 1990-1998. The mainstay of treatment was surgery with adjuvant chemotherapy and radiotherapy reserved for selected patients with early stage disease. Overall 1 and 2 year survival was 49% and 30% respectively compared with 73% and 55% in the group who received adjuvant chemotherapy/radiotherapy. Median survival was 11 months for the group as a whole compared to 32.9 months in the adjuvant therapy group. This is a retrospective review with small numbers and considerable selection bias, however, given the poor survival of patients with this disease, adjuvant treatment should be considered in future trials of patients with uterine sarcoma.
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Affiliation(s)
- P J Riddle
- Department of Clinical Oncology, Churchill Hospital, Oxford, UK
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Deniaud-Alexandre E, Chauveinc L, de la Rochefordière A, Sastre X, Clough KB. [Role of adjuvant therapy in uterine sarcoma: experience of the Curie Institute]. Cancer Radiother 2001; 5:743-9. [PMID: 11797295 DOI: 10.1016/s1278-3218(01)00133-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Uterine sarcoma is a rare disease and survival is poor. From 1975 to 1995, 73 uterine sarcomas were treated at the Curie Institute, and we analysed prognostics factors of survival. PATIENTS AND METHODS Seventy-one patients underwent primary surgery, in most cases a radical non conservative surgery and a lymphadenectomy. Every patient had an irradiation (external beam irradiation and/or brachytherapy), and 24 patients received adjuvant chemotherapy. We observed that youngest patients had more leiomyosarcomas and low histologic grade tumours. Median survival was 42 months, and 5-years survival and local control were 36 and 68% respectively. Pelvic recurrences were most often before 2 years. This series demonstrates the impact of adjuvant irradiation on local control. This impact was stronger if the tumour had a high histologic grade (p < 0.01). However, irradiation, as well as chemotherapy, had no impact on the survival. CONCLUSION The study confirmed that irradiation enable a better local control. However modalities of radiation therapy (brachytherapy and/or external beam radiotherapy, dose, volume), are still controversed.
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Affiliation(s)
- E Deniaud-Alexandre
- Service de radiothérapie, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
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Maluf FC, Sabbatini P, Schwartz L, Xia J, Aghajanian C. Endometrial stromal sarcoma: objective response to letrozole. Gynecol Oncol 2001; 82:384-8. [PMID: 11531300 DOI: 10.1006/gyno.2001.6238] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Low-grade endometrial stromal sarcoma is generally an indolent tumor rich in estrogen and progesterone receptors. Objective responses to hormonal therapy, most commonly with megestrol acetate, have been reported. CASE The patient is a 51-year-old woman who presented with low-grade endometrial stromal sarcoma confined to the uterus in 1991 and was treated with total abdominal hysterectomy and bilateral salpingo-oophorectomy. Approximately 5 years later, the patient had recurrent pelvic disease treated with radiation therapy, followed by an attempt at resection. She was treated with megestrol acetate during the period she received radiation therapy with poor tolerance. Tamoxifen was then given with no tumor response. Megestrol acetate was restarted with progression of disease in the pelvis and abdomen. Letrozole was then given at a daily dose of 2.5 mg with partial response for a duration of 9 months. CONCLUSION Letrozole at a daily dose of 2.5 mg may be effective in low-grade endometrial stromal sarcoma with positive estrogen receptors.
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Affiliation(s)
- F C Maluf
- The Developmental Chemotherapy Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, New York 10021, USA
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Weitmann HD, Knocke TH, Kucera H, Pötter R. Radiation therapy in the treatment of endometrial stromal sarcoma. Int J Radiat Oncol Biol Phys 2001; 49:739-48. [PMID: 11172957 DOI: 10.1016/s0360-3016(00)01369-9] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The efficacy of radiation therapy in the treatment of endometrial stromal sarcoma (ESS) is still not clear. We report our results over an 18-year period in comparison to data from literature concerning adjuvant radiation therapy and other treatment modalities. PATIENTS AND METHODS During 1981-1998, 21 patients with ESS were treated at General Hospital Vienna. The age of the patients ranged between 44-76 years (median: 65 yr). The 1989 FIGO classification for endometrial carcinoma was used in this study retrospectively. Eleven patients presented in Stage I, 1 in Stage II and 5 in Stage III. Four patients had Stage IV tumors or recurrences. The majority of patients (66.7%) had a Grade 3 tumor. Seventeen patients were treated in a curative intent. Fifteen patients were referred for postoperative radiotherapy after hysterectomy. Thirteen of them received a combined radiotherapy. Two patients were referred for primary radiotherapy. They received a combined radiotherapy. Four patients were referred for radiotherapy with a palliative intent. Twenty patients received external beam therapy (EBT) in daily fractions of 1.6-2.0 Gy up to a total dose of 27-57 Gy to the pelvis. Seventeen patients received brachytherapy. RESULTS Follow-up was 8 to 170 months (mean: 70.3 months, median: 64 months). Eleven patients are still alive, 10 without tumor and 1 with tumor. Ten patients are dead, 6 due to ESS, 1 due to breast cancer, and 3 due to intercurrent diseases. After adjuvant radiotherapy, 3 patients had tumor recurrences. All had distant metastases, and 1 had local failure additionally. Two patients with primary treatment died due to intercurrent disease without tumor. The overall actuarial survival and the disease-specific survival rates were 63.4% and 80.9% after 5 years and 52.8% and 80.9% after 10 years. The overall local control rate was 93.8% after 5 years. Four patients treated with a palliative intent showed partial response. Three patients died rapidly due to tumor. One patient with a Grade 1 tumor is still alive 12 months after treatment. CONCLUSION In our experience, surgery and adjuvant radiation therapy are most effective treatments for patients with ESS due to the excellent local control in all stages and the good disease-specific survival in early stages.
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Affiliation(s)
- H D Weitmann
- Department of Radiotherapy and Radiobiology, University of Vienna at the General Hospital Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
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