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Published on: February 12, 2017
High-dose insulin and dexamethasone combined with radiotherapy in endometrial stromal sarcoma recurring with multiple
Libin Liang1, Jun Wang2, Jing Xie3
1Xinglong Institute of Pharmaceutical and Medical Science, Shijiazhuang, China.
Rationale:
Endometrial stromal sarcoma (ESS) is a rare malignant tumor. There is insufficient data supporting the efficiency of current treatments in multiple metastatic settings, and novel therapeutic options for ESS are considered an area of high unmet clinical need.
Patient Concerns:
We report the case of a 28-year-old woman who was diagnosed with ESS after undergoing total hysterectomy and left adnexectomy at another hospital. Two years later, the disease recurred, with multiple abdominal cavities and lung metastases. The patient was treated with a variety of chemotherapeutic drugs, including tyrosine kinase inhibitors, at the same hospital; however, none of them inhibited disease progression.
Diagnoses:
Computed tomography (CT) revealed multiple masses in the abdominal and pelvic cavities and multiple pulmonary nodules. Ultrasound-guided biopsy was performed and the tumor tissue was histologically confirmed after treatment.
Interventions:
Insulin 300-400 IU was administrated by intravenous infusion in 10% glucose (500 mL) with disodium adenosine triphosphate 60 mg, coenzyme A 100 units, 10% potassium chloride 5 mL and 25% magnesium sulfate 5 mL. Dexamethasone (20-25 mg/d) was diluted with 10 mL of 2% lidocaine and then intraperitoneally injected after ascites draw. After 9 months, the patient was referred to another center for radiotherapy.
Outcomes:
CT images tomography showed recurrent pelvic masses, and multiple abdominal cavity and lung metastases gradually shrunk with treatment. Histological biopsy revealed growth arrest of tumor cells. The patient experienced for 3-years survival.
Lessons:
High-dose insulin and dexamethasone combined with radiotherapy provides a novel and promising option for patients with multiple ESS metastases.
Insights
High-dose insulin and dexamethasone combined with radiotherapy showed promise for treating metastatic endometrial stromal sarcoma (ESS). This novel approach led to tumor shrinkage and a 3-year survival in a patient with advanced disease.
Area of Science:
- Oncology
- Medical Research
- Cancer Therapeutics
Background:
- Endometrial stromal sarcoma (ESS) is a rare malignancy with limited treatment options for multiple metastatic sites.
- There is a significant unmet clinical need for effective therapies in advanced ESS.
- Current treatments often fail to inhibit disease progression in recurrent or metastatic settings.
Observation:
- A 28-year-old woman with recurrent ESS and widespread metastases (abdominal, pelvic, and lung) showed no response to conventional chemotherapy, including tyrosine kinase inhibitors.
- Computed tomography (CT) confirmed multiple masses and pulmonary nodules.
- Histological confirmation of tumor tissue was obtained.
Findings:
- A novel treatment regimen involving high-dose insulin, dexamethasone, and subsequent radiotherapy was administered.
- The combined therapy resulted in significant shrinkage of pelvic masses, abdominal cavity, and lung metastases.
- Histological analysis indicated growth arrest of tumor cells, and the patient achieved a 3-year survival.
Implications:
- High-dose insulin and dexamethasone, in combination with radiotherapy, represent a promising therapeutic strategy for managing multiple ESS metastases.
- This case report suggests a potential new avenue for treating advanced endometrial stromal sarcoma.
- Further research is warranted to validate this combination therapy in a larger patient cohort.
