Clinical study investigating the role of lymphadenectomy, surgical castration and adjuvant hormonal treatment in endometrial stromal sarcoma

Abstract

The objective of this study is to assess the therapeutic importance of surgical castration, adjuvant hormonal treatment and lymphadenectomy in endometrial stromal sarcoma (ESS). A retrospective and multicentric search was performed. Clinicopathologic data were retrieved from cases that were confirmed to be ESS after central pathology review. The protocol was approved by the Ethical Committee. ESS was confirmed histopathologically in 34 women, but follow-up data were available in only 31 women. Surgical treatment (n ¼ 31) included hysterectomy with or without bilateral salpingo-oophorectomy (BSO) in 23 out of 31 (74%) and 8 out of 31 (26%) cases, respectively. Debulking surgery was performed in 6 out of 31 cases (19%). Stage distribution was as follows: 22 stage I, 4 stage III and 5 stage IV. Women with stage I disease recurred in 4 out of 22 (18%) cases. Among stage I women undergoing hormonal treatment with or without BSO, 3 out of 15 (20%) and 1 out of 7 (14%) relapsed, respectively. Among stages III -IV women receiving adjuvant hormonal treatment or not, 1 out of 5 (20%) and 3 out of 4 (75%) relapsed, respectively (differences ¼ 55.0%, 95% CI ¼ À6.8 -81.2%). Kaplan -Meier curves show comparable recurrence rates for stage I disease without adjuvant hormonal treatment when compared to stages III -IV disease treated with surgery and adjuvant hormonal treatment. Furthermore, women taking hormones at diagnosis have a better outcome when compared to women not taking hormonal treatment. Three out of 31 (9%) patients had a systematic lymphadenectomy whereas 3 out of 31 (9%) had a lymph node sampling. In one case, obvious nodal disease was encountered at presentation. Isolated retroperitoneal recurrence occurred in 1 out of 31 (3%) of all cases and in 1 out of 8 (13%) recurrences. This single woman later also developed lung and abdominal metastases. Leaving lymph nodes in situ does not appear to alter the clinical outcome of ESS. Although numbers are low, the retrospective data suggest that the need for surgical castration (BSO) in premenopausal women with early-stage disease should be discussed with the patient on an individual basis. The data support the current practice in some centres to administer adjuvant hormonal treatment.

Endometrial stromal sarcoma: a population-based analysis

“…Similarly, Li et al (2005) found that ovarian preservation did not affect recurrence or survival in women with stage I low-grade ESS. Similar findings were described by Amant et al (2007) in a multicenter analysis of 34 women with ESS. In stage I -II premenopausal women who underwent hysterectomy with or without bilateral saplingo oophorectomy, 3 of 12 (25%) and 1 of 6 (17%) recurred, respectively.…”

“…The standard surgical procedure has included a total abdominal hysterectomy, bilateral salpingo-oophorectomy, and radical cytoreductive surgery of extra-uterine disease (Gadducci et al, 1996). Moreover, despite traditional recommendations to include bilateral salpingooophorectomy in the primary surgical management of ESS, some investigators have advocated preserving ovarian function, particularly in younger women (Gadducci et al, 1996;Chu et al, 2003;Li et al, 2005;Amant et al, 2007). The role of pelvic and para-aortic lymphadenectomy, and adjuvant therapy with radiation therapy, chemotherapy, or hormonal treatment remains controversial.…”

Prognostic Value of the Diagnostic Criteria Distinguishing Endometrial Stromal Sarcoma, Low Grade From Undifferentiated Endometrial Sarcoma, 2 Entities Within the Invasive Endometrial Stromal Neoplasia Family

“…The problem with regard to earlier studies is that the various conditions were aggregated, preventing meaningful analysis of any single variable (6)(7)(8)(9)(10)(11)(12)(13). Further, some recent studies are still using the older classification (14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) …”

Assessment of MR Imaging as a Tool to Differentiate between the Major Histological Types of Uterine Sarcomas

“…7,9 Standardized treatments for uterine sarcomas have not been established, and treatments differ according to the histological subtype. [7][8][9][10] Because of these diagnostic, prognostic, and therapeutic differences, magnetic resonance (MR) imaging becomes an important tool for the initial diagnosis of uterine sarcoma. Several studies have presented MR findings of uterine sarcoma, but diagnosing and distinguishing specific sarcoma groups have been difficult because of the variability of their malignant components, including hemorrhage and necrosis.…”