Treatment options in stage I endometrial stromal sarcoma: a retrospective analysis of 53 cases

To discuss the optimal treatment options for stage I patients with endometrial stromal sarcoma (ESS).

We reviewed hospital records and pathology of 53 patients with ESS at stage I. Statistical analysis was performed using SPSS 12.0 software, and Chi-square test, t-test and log rank test were adopted.

Among 53 patients, 37 had low-grade tumors, 11 had undifferentiated endometrial sarcoma (UES) and 5 had unclassified ESS. The median follow-up time was 66 months, and 48 cases were still alive. The overall 2-year and 5-year survival rates were 91.5% and 85.9%, respectively. The recurrence rate of the patients with preserved ovarian function was remarkably higher than that of patients without (100% vs. 22.7%, P<0.001). The patients who received adjuvant whole pelvic radiation (Dt 40 approximately 45 Gy) had obviously higher local control rate than the patients who did not (93.8% vs. 57.1%, P=0.007), but they had similar survival (P=0.963). Among 7 of the 11 UES patients without distant recurrence, 5 received the adjuvant chemotherapy with IAP (ifosfamide 1.0 g, d1-4; epirubicin 25 mg/m2, d1-2; cisplatin 20 mg, d1-5; mensa 0.2 g, 0, 4, 8 h from the application of ifosfamide, d1-4, q 28 days) or VAD (vincristine 1.2 mg/m2, d1; adriamycin 20 mg/m2, d1-3; dacarbazine 250 mg/m2, d1-5, q 28 days), and none of the other 4 cases recurring distantly received the chemotherapy with IAP or VAD.

Surgeries not preserving ovarian function were helpful to decrease the risk of recurrence compared with those surgeries sparing ovarian function. Adjuvant radiotherapy could improve local control but not survival. Adjuvant chemotherapy with IAP or VAD seemed to be beneficial to UES patients.