gynecology and obstetrics
Uterine Sarcomas
Treatment of Uterine Sarcomas
Total abdominal hysterectomy and bilateral salpingo-oophorectomy Usually adjuvant pelvic radiation therapy Chemotherapy for advanced or recurrent cancers (See alsoNational Comprehensive Cancer Network (NCCN): NCCN Clinical Practice Guidelines in Oncology: Uterine Sarcomas.) Treatment of uterine sarcomas is total abdominal hysterectomy and bilateral salpingo-oophorectomy. Uterine sarcomas should be removed en bloc; morcellation is contraindicated. If a specimen is fragmented during surgery, imaging is recommended to check for metastases, and re-exploration can be considered. Treatment with chemotherapy is also recommended. The ovaries may be preserved in certain patients with early-stage uterine leiomyosarcoma if they wish to retain hormonal function. Additional surgical resection should be based on intraoperative findings. Lymphadenectomy in patients with leiomyosarcoma or endometrial stromal sarcoma is not indicated because there is evidence that the risk of lymph node metastases is minimal (< 2%) ( Treatment references , For inoperable sarcomas, pelvic radiation therapy with or without brachytherapy and/or systemic therapy is recommended. Adjuvant radiation therapy is typically used and appears to delay local recurrence but does not improve overall survival rate. Chemotherapy agents are typically used when tumors are advanced or recur; drugs vary by tumor type. Some preferred regimens are Doxorubicin Docetaxel/gemcitabine(preferred for leiomyosarcoma) Overall, response to chemotherapy is poor. alone resulted in significantly increased median progression-free survival (12.2 versus 6.2 months; adjusted hazard ratio, 0·41) ( Treatment references ). Endocrine therapy is used for patients with endometrial stromal sarcoma or hormone receptor–positive uterine leiomyosarcoma. Progestins are frequently effective. Endocrine therapy may include: Medroxyprogesteroneacetate Megestrolacetate Aromatase inhibitors GnRH (gonadotropin-releasing hormone) agonists 1.Smith ES, Jansen C, Miller KM, et al: Primary characteristics and outcomes of newly diagnosed low-grade endometrial stromal sarcoma.Int J Gynecol Cancer32(7):882-890, 2022. Published 2022 Jul 4. doi:10.1136/ijgc-2022-003383 2.Leitao MM, Sonoda Y, Brennan MF, et al: Incidence of lymph node and ovarian metastases in leiomyosarcoma of the uterus.Gynecol Oncol91(1):209-212, 2003. doi:10.1016/s0090-8258(03)00478-5 3.Pautier P, Italiano A, Piperno-Neumann S, et al:Doxorubicinalone versusdoxorubicinwithtrabectedinfollowed bytrabectedinalone as first-line therapy for metastatic or unresectable leiomyosarcoma (LMS-04): a randomised, multicentre, open-label phase 3 trial.Lancet Oncol23(8):1044-1054, 2022. doi:10.1016/S1470-2045(22)00380-1 