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METASTATIC ENDOMETRIAL STROMAL SARCOMA - TREATMENT WITH DOXORUBICIN AND CARBOPLATIN FOLLOWED BY MEDROXY- PROGESTERON ACETATE MAINTANANCE

Endometrial stromal sarcoma (ESS) is very rare uterine malignancy and there are few reports about chemotherapy efficacy in advanced disease. Although presence of estrogen (ER) and progesterone (PGR) receptors is reported, the role of hormonal therapy is controversial. Objective of this prospective study is to determine the effectiveness and toxicity of doxorubicine plus carboplatin, and significance of maintenance with MPA in metastatic or recurrent ESS. Patients and Methods: During 7 years, 13 chemotherapy naive patients were treated (high-grade-7pts, intermediate grade-6pts). Median age was 53, range 33—70 years. ER/PGR status of the primary tumor was unknown. All pts were treated with doxorubicin 50mg/m2 (day 1) and carboplatin AUC 5 (day 2) every 4 weeks for maximum 8 cycles. Median, 4 cycles per patient was given. After chemotherapy completion/cessation, pts continued with MPA 500mg as maintenance or supportive therapy. Responses were 1 CR, 4 PR (RR 45,4%), 4 SD and 3 PD, while 1 patient was not evaluable. The most significant toxicity, registered only in 6 previously irradiated pts, were tromboand neutropenia grade III-IV, with 2 febrile neutropenia episodes, but without fatal events. CR lasted 11 months and longest PR lasted 46 months. Eleven pts continued with MPA. The benefit of MPA was registered only in the patient with long lasting PR who had complete recovery of previous 30 kg weight loss. Conclusion: Doxorubicin and carboplatin is active combination in ESS with significant but manageable toxicity. The significance of maintenance therapy with MPA could not be determined.