Fertility-Sparing Management May Be Considered in Young Women with Uterine Sarcoma

Abstract

Uterine sarcomas occur very rarely in young women. Hysterectomy, which is a standard treatment, may not be acceptable for those patients, especially nulliparous women. Fertility-sparing management may be an alternative. The aim of the study was to assess fertility-sparing management in patients with uterine sarcoma. Eleven patients were eligible for the study. Histopathologic types of the tumor included: adenosarcoma (n = 3), low-grade endometrial stromal sarcoma (n = 3), low-grade myofibroblastic sarcoma (n = 1), leiomyosarcoma (n = 1), leiomyosarcoma myxoides (n = 1), rhabdomyosarcoma (n = 1), high grade endometrial stromal sarcoma (n = 1). The mean age of the patients at the time of diagnosis was 27.4 years (range: 17–35) and the average follow-up 61 months (range: 12–158). Six patients received adjuvant treatment: megestrol (n = 5) and chemotherapy (n = 1). Recurrence was diagnosed in five cases. Median time to recurrence was 35 months (range: 8–90). Three patients conceived spontaneously following treatment and gave at least one live birth. In total, five full-term pregnancies were recorded and five healthy children were born. Fertility-sparing management may be considered in some patients with uterine sarcoma; however, it may not be appropriate in high-grade endometrial stromal sarcoma. Patients with adenosarcoma may have a low chance of childbearing.

Intravenous metastasis of unexpected uterine sarcoma in the context of uterine fibroids: case report and literature review

“…However, postoperative pathology revealed the coexistence of both LGESS and HGESS. LGESS commonly presents in perimenopausal women and is rarely reported in young women and adolescents ( 12 ). Risk factors shared among these age groups include obesity, diabetes, early menarche, and the use of tamoxifen and estrogen medications ( 9 , 13 , 14 ).…”

Reproductive Results in Cancer Survivors after Fertility Sparing Management: The Need for the Standardization of Definitions

“…The importance of FSM in clinical practice is constantly rising in various gynecological tumors, even in selected cases of uterine sarcomas [77]. FSM is an alternative to radical oncological treatment for young cancer patients.…”

Clinicopathologic characteristics, treatment, prognosis and pregnancy outcomes in rhabdomyosarcoma of the uterine cervix: a case series

“…However, there are fewer reports on pregnancy outcomes after treatment. Piątek S et al reported a 22-year-old woman diagnosed with RMS of the cervix who had two successful deliveries without disease recurrence [22]. A recent systematic review found that of 35 enrolled patients with cervical ERMS, 3 had a successful pregnancy (3/35, 9%), and their pregnancy rates were lower than those of patients with other uterine sarcomas, such as low-grade endometrial stromal sarcoma (27/63, 43%), adenosarcoma (4/19, 21%), and smooth muscle tumour of uncertain malignant potential (29/84, 35%) [23].…”

“…A recent systematic review found that of 35 enrolled patients with cervical ERMS, 3 had a successful pregnancy (3/35, 9%), and their pregnancy rates were lower than those of patients with other uterine sarcomas, such as low-grade endometrial stromal sarcoma (27/63, 43%), adenosarcoma (4/19, 21%), and smooth muscle tumour of uncertain malignant potential (29/84, 35%) [23]. The low pregnancy rates among patients with RMS may be caused by fertility impairment and multidrug chemotherapy, especially high doses of alkylating agents such as cyclophosphamide and ifosfamide [2,22]. In our study, 4 patients received fertility-sparing treatment, and 1 successfully conceived and delivered (25%).…”