Ovarian Preservation in Stage I Low-Grade Endometrial Stromal Sarcomas

University of Texas at Dallas, Richardson, Texas, United States
Obstetrics and Gynecology (Impact Factor: 5.18). 01/2006; 106(6):1304-8. DOI: 10.1097/01.AOG.0000185511.91694.1e
Source: PubMed


To examine the impact of ovarian preservation in a case-control study of women with stage I low-grade endometrial stromal sarcomas.
Patients with low-grade endometrial stromal sarcomas were identified at 5 institutions from 1976 to 2002. Cases were defined as patients who retained ovarian function; each case was matched to 2 control patients who underwent bilateral salpingo-oophorectomy (BSO). Immunostaining for estrogen and progesterone receptors was performed. Data were examined with Student t, chi(2), Cox regression, and Kaplan-Meier analyses.
Twelve premenopausal patients with low-grade endometrial stromal sarcomas who did not undergo BSO were matched to 24 controls. Of the 36 patients in the entire cohort, disease recurred in 14 (39%). Recurrences were identified in the pelvis, abdomen, lung, or lymphatics in both cases and controls. Disease recurred in 4/12 (33%) case patients, compared with 10/24 (42%) control patients (P = .63). When case patients were compared with controls, no differences in progression-free (91.3 months versus 68.6 months, P = .44) or overall survival (median survival not yet reached versus 406 months, P = .82) were identified. This study had 13% power to detect the observed difference in median disease-free survival. After controlling for use of adjuvant therapy and BSO, older age remained the only independent poor prognostic factor for progression-free survival (P = .008). Twenty-two available tumors demonstrated positivity for both estrogen and progesterone receptors.
Bilateral salpingo-oophorectomy did not appear to affect time to recurrence or overall survival. Retention of ovarian function may be an option for premenopausal women with low-grade endometrial stromal sarcomas.

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    • "In patient without a desire of fertility or with menopause, a total hysterectomy and bilateral salpingo-oophorectomy was recommended. However, Li et al5 recently demonstrated that ovarian preservation could be a safe option for surgical treatment in stage I, low-grade ESS. The importance of surgical staging operation and adjuvant treatment is still unknown.6,7 "
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    ABSTRACT: Objective: To evaluate clinico-pathological features and prognostic valuses of Endometrial stromal sarcomas (ESS) through comparison of the two grade groups (low- and high-grade disease). Methodology: We retrospectively analyzed the medical records of 27 patients who were diagnosed with ESS at a single institute between March 1988 and November 2009. Our retrospective chart review was approved by our local institutional Review Board (IRB). Results: The median age of the patients was 44.0 years, the median follow-up period was 101.0 months and the 10-year survival rate was 74.2%. The median uterine weight was 215.0 gm. Twenty-three (70.4%) and four patients (29.6%) had low- and high-grade disease, respectively. As primary treatment, twenty-four (70.4%) and three patients (11.1%) underwent type I hysterectomy and type III hysterectomy, respectively. Total six cases were recurred and two cases of the six-recurred patients were distant metastasis (lung) and four cases were died of the disease. Univariate analysis revealed that the histologic grade and the uterine tumor weight were significantly related with longer disease-free survival (p=0.025 and 0.043 respectively). Conclusion: ESSs with high-grade or larger tumor size have to be carefully and sufficiently managed, because of its rarity and aggressive behavior. To determine the proper adjuvant treatment of ESS with high risks, further clinical data should be collected and studied.
    Full-text · Article · Mar 2013 · Pakistan Journal of Medical Sciences Online
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    • "Surgery has always been described as the most effective treatment for uterine sarcomas. Total abdominal hysterectomy with bilateral salpingo-oophorectomy is considered to be the standard treatment for ESS [3] [21] [25] [26]. Some data on small series reported a nodal involvement in 33–45% of the patients undergoing lymph node dissection during primary or secondary surgical treatment, thus suggesting a role for lymphadenectomy in this malignancy [27] [28] [29]. "
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    ABSTRACT: Endometrial stromal tumor is a rare mesenchymal uterine tumor. We report the case of a patient with endometrial stromal sarcoma and concomitant bilateral endometrioid adenocarcinoma of the ovary in the context of pelvic endometriosis. The patient underwent a complete cytoreduction including total hysterectomy and bilateral adnexectomy, pelvic lymphadenectomy, appendicectomy, infracolic omentectomy, and pelvic peritonectomy. This is the first report to our knowledge that describes a synchronous endometrial stromal sarcoma and bilateral endometrioid adenocarcinoma of the ovary.
    Full-text · Article · Nov 2012
    • "Therefore, the standard surgical treatment considered total hysterectomy, with bilateral salpingo-ophorectomy, and hormone replacement therapy is contraindicated postoperatively.[1819] However, various studies have shown bilateral salpingo-oophorectomy did not appear to affect time for recurrence or overall survival in stage-I ESS.[20–24] Considering the adverse effects of early surgical menopause, retention of ovarian function may be an option for premenopausal women with stage-I ESS.[25] In all other stages, total hysterectomy with bilateral salpingo-ophorectomy is recommended. "
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    ABSTRACT: Endometrial stromal sarcomas are rare malignant tumors of the uterus, and most of the information available in literature is based on small series or case reports. A proper preoperative diagnosis is difficult and in most cases the diagnosis is confirmed after hysterectomy for a presumed benign disease. Endometrial sampling, ultrasound, and magnetic resonance imaging can provide diagnostic clues. Total hysterectomy with bilateral salpingo-oopherectomy is the main line of management and for early disease complete cure is a reality. Ovarian conservation may be possible in young women with early stage disease and the role of lymphadenectomy is controversial. Adjuvant hormone therapy in the form of progesterone, gonadotropin releasing hormone analogues, and aromatase inhibitors are found to be effective in preventing recurrences. Hormone therapy, radiotherapy and surgical excision of the metastasis are recommended for recurrences.
    No preview · Article · Mar 2012 · Indian journal of medical and paediatric oncology
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