Fertility-sparing treatment of low-grade endometrial stromal sarcoma

Low-grade endometrial stromal sarcoma (ESS) is a kind of uterine malignancy. Total hysterectomy and bilateral salpingo-oophorectomy was the main treatment. We evaluate the feasibility of fertility-sparing management in five patients with low-grade ESS who desired for childbearing. The patients aged 28-36 years old presented with symptoms of menometrorrhagia or without symptom. Ultrasound examinations demonstrated leiomyomas (with the diameter of 3.5-6 cm respectively). All the patients received conservative surgeries of local resection of the mass with uterine reconstruction. Then the adjuvant endocrine therapy was given to them with megestrol acetate (160-320 mg/day) or triptorelin (3.75 mg/28 days) for 5-6 months. The follow-up lasted 21-55 months. All the patients survived. Three of them underwent an uncomplicated pregnancy, and received cesarean delivery of a liveborn neonate. One of them is alive without disease recurrence. The other one found disease recurred during the megestrol acetate treatment, and received hysterectomy. We consider that fertility-sparing treatment is suitable in selected in young low-grade ESS patients especially for those whose lesion was with a clear borderline. Adjuvant endocrine therapy is recommended for about 6 months after operation.