Uterine Preservation Treatments in Sarcomas: Oncological Problems and Reproductive Results: A Systematic Review

Abstract

Uterine sarcomas are rare cancers, sometimes diagnosed in women of childbearing age. Hysterectomy is the standard treatment in early stages. The option of lesion removal to save fertility is described in the literature, but it is still considered experimental. The objective of this systematic review is to report on the available evidence on the reproductive and oncological outcomes of fertility-sparing treatment in women with uterine sarcomas. PubMed, Scopus and Cochrane Central Register of Controlled Trials were searched between 1 January 2011 and 21 June 2021 for publications in English about women with uterine sarcoma treated with a fertility-sparing intervention. Thirty-seven studies were included for a total of 210 patients: 63 low-grade endometrial stromal sarcomas, 35 embryonal rhabdomyosarcomas of the cervix, 19 adenosarcomas, 7 leiomyosarcomas and 2 uterine tumors resembling an ovarian sex cord. Conservative treatment ensured pregnancy in 32% of cases. In terms of oncological outcomes, relapse was related to histology and the worst prognosis was reported for leiomyosarcoma, followed by low-grade endometrial stromal sarcoma, which relapsed in 71% and 54% of cases, respectively. The highest death rate was associated with leiomyosarcoma (57.1%). This study demonstrated that fertility-sparing treatments may be employed in selected cases of early stage uterine sarcoma.

Case Report: Uterine Adenosarcoma With Sarcomatous Overgrowth and Malignant Heterologous Elements

“…The treatment of choice is surgical, performing total abdominal hysterectomy or by laparoscopic approach, with or without bilateral salpingo-oophorectomy; in women of reproductive age, a myomectomy and polypectomy may be chosen. There is no standardized chemotherapy, hormonal therapy, or radiation therapy in UA, due to the small number of patients with this neoplasia; however, standardized chemotherapy for uterine sarcomas, such as doxorubicin, ifosfamide, or gemcitabine/docetaxel, and newer drugs, such as trabectedin, appear to have some efficacy in UASO ( 16 , 17 ).…”

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

“…In our study, three (27.27%) patients conceived and a total of five children were born. The most recent systematic review regarding uterine preservation treatment in sarcomas was published by Dondi et al (2021) [ 39 ]. The authors reported to have found 37 eligible papers, of which only four were case series, like our study.…”

Low-Grade Uterine Endometrial Stromal Sarcoma: Prognostic Analysis of Clinico-Pathological Characteristics, Surgical Management, and Adjuvant Treatments. Experience From Two Referral Centers

“…In a large cohort of 153 LG-ESS, 19 patients underwent myomectomy with ovary-sparing procedures to preserve fertility, and 4 (21%) developed recurrence ( 8 ). Recently, a systematic review focused on fertility-sparing surgery for uterine sarcomas reported a recurrence risk of 54%, however, this result was based on 5 very heterogeneous studies with a relatively low number of patients ( 18 ).…”