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Surgery and adjuvant radiation therapy of endometrial stromal sarcoma
Hajo Dirk Weitmann1, Herwig Kucera, Tomas-Hendrik Knocke
1Department of Radiotherapy and Radiobiology, University of Vienna, General Hospital Vienna, Austria. Dirk.Weitmann@str.akh.magwien.gv.at
Objective:
In the treatment of endometrial stromal sarcoma, it is still not clear whether adjuvant radiation therapy improves the outcome. We wish to summarize the experiences we gathered from treating 15 patients over a period of 18 years, and to compare these to results from literature.
Patients And Methods:
According to the 1989 FIGO classification for endometrial carcinoma, 11 (73%) of the 15 patients analyzed presented stage I, 1 presented stage II, and 3 presented stage III sarcoma. Of these, 11 patients (73%) had high grade stromal sarcoma and 4 had low grade stromal sarcoma. All patients were treated with surgery and adjuvant radiation therapy. Total abdominal hysterectomy and bilateral salpingo-oophorectomy was performed on 11 patients (73%), vaginal hysterectomy and bilateral salpingo-oophorectomy on 2 patients, and total abdominal hysterectomy on 2 patients. Combined radiotherapy was performed on 13 patients (93%), while isolated brachytherapy and isolated external beam therapy were each performed on 1 patient. External beam therapy was administrated in daily fractions of 1.6-2.0 Gy up to a total dose of 37-57 Gy to the pelvis.
Results:
Follow up ranged from 23 to 170 months (mean: 80 mths). 10 patients (67%) are still alive without tumor, and 5 patients have died. Of these, one died due to intercurrent disease, one due to breast-cancer, and 3 due to endometrial stromal sarcoma, presenting distant metastases within one year after therapy. Only one patient presented with an additional local recurrence. The overall actuarial survival and the disease specific survival rate was 72% and 79% respectively after 5 years, and 60% and 79% after 10 years. The overall local control rate was 93% after 5 years. There were no severe acute side effects and no late side effects.
Conclusion:
In our experience, the most effective treatment for patients with endometrial stromal sarcoma is total abdominal hysterectomy and bilateral salpingo-oophorectomy followed by adjuvant radiation therapy, due to the excellent local monitoring possibilities in all stages of disease, and a good disease specific survival in early stages.