Survey of adjuvant hormone therapy in patients after endometrial stromal sarcoma

Introduction: We surveyed the use of adjuvant hormonal therapy in patients with endometrial stromal sarcomas.

Material and methods: A questionnaire was circulated among the 130 members of an Internet-based endometrial stromal sarcoma support group. The questions pertained to age at diagnosis, organs involved at diagnosis, recurrences, metastases, current disease status, and treatment protocols, with special focus on hormonal therapy.

Results: The questionnaire was returned by 64 of 120 women (49%). At the time of the study 48 patients (mean follow-up 2.4 (range, 1-9) years) had no evidence of disease (NED) and 16 (mean follow-up 6.2 (range, 1-22) years) were alive with disease (AWD). Of the 16 women AWD, 15 (95%) were being treated with hormones as opposed to ten of 48 (21%) women with NED. Hormone treatment consisted of progestins (15 patients), aromatase inhibitors, aromatase inhibitor plus GnRH analog], or tamoxifen.

Discussion: Adjuvant hormonal therapy presently appears to be used predominantly in women with advanced or recurrent endometrial stromal sarcomas but is also a potential option for patients after surgery without residual tumor.

Endometrial stromal sarcoma; Hormonal therapy

[1] Koss L.G., Spiro R.H., Brunschwig A.: "Endometrial stromal sarcoma". Surg. Gynecol. Obstet., 1965, 121, 531.

[2] Chang K.L., Crabtree G.S., Lim-Tan S.K., Kempson R.L., Hendrickson M.R.: "Primary uterine endometrial stromal neoplasms. A clinicopathologic study of 117 cases". Am. J. Surg. Pathol., 1990, 14, 415.

[3] Piver M.S., Rutledge F.N., Copeland L., Webster K., Blumenson L., Suh O.: "Uterine endolymphatic stromal myosis: a collaborative study". Obstet. Gynecol., 1984, 64, 173.

[4] Reich O., Regauer S.: "Endometrial stromal sacoma - observational evidence of a genetic background". Eur. J. Gynaecol. Oneal., 2005, 26, 288.

[5] Reich O., Regauer S., Urdl W., Lahousen M., Winter R.: "Estrogen and progesterone receptors in low-grade endometrial stromal sarcomas". Br. J. Cancer, 2000, 82, 1030.

[6] Reich O., Regauer S.: "Aromatase expression in low-grade endometrial stromal sarcomas: an immunohistological study". Mod. Path., 2004, 17, 104.

[7] Reich O., Nogales F.F., Regauer S.: "Gonadotropin-releasmg hormone receptor expression in endometrial stromal sarcomas: an immunohistochemical study". Mod. Path., 2005, 18, 573.

[8] Katz L., Merino M.J., Sakamoto H., Schwarz P.E.: "Endometrial stromal sarcoma: a clinicopathologic study of 11 cases with determination of estrogen and progestin receptor levels in three tumors". Gynecol. Oneal., 1987, 26, 87.

[9] Pellillo D.: "Proliferative stromatosis of the uterus with pulmonary metastases. Remission following treatment with a long acting synthetic progestin: A case report". Obstet. Gynecol., 1968, 31, 33.

[10] Baggish M.S., Woodruff J.D.: "Uterine stromatosis: clinicopathologic features and hormone dependency". Obstet. Gynecol., 1972, 40, 487.

[11] Krumholz B.A., Lobovsky F.Y., Halitsky V.: "EndolymphatJc stromal myosis with pulmonary metastases. Remission with progestin therapy: Report of a case". J. Reprod. Med., 1973, 10, 85.

[12] Gloor E., Schneyder P., Cikes M., Hofstetter J., Cordey R., Burmer F., Knobel P.: "Endolymphatic stromal myosis. Surgical and hormonal treatment of extensive abdominal recurrence 20 years after hysterectomy". Cancer, 1982, 50, 1888.

[13] Baker VY., Walton L.A., Fowler W.C., Currie J.L.: "Steroid receptors in endolymphatic stromal myosis". Obstet. Gynecol., 1984, 63, 72.

[14] Tsukamoto N., Kamura T., Matsukuma K., Imachi M., Uchino H., Saito T., Ono M.: "Endolymphatic stromal myosis: a case with positive estrogen and progesterone receptors and good responce to progestins". Gynecol. Oncol., 1985, 20, 120.

[15] Keen C.E., Ph山p G.: "Progesterone-induced regression in lowgrade endometrial stromal sarcoma. Case report and literature review". Br. J. Obstet. Gynaecol., 1989, 96, 1435.

[16] Montag T.W., Manart F.D.: "Endolymphatic stromal myos1s: surgical and hormonal therapy for extensive venous recurrence". Gynecol. Oneal., 1989, 33, 255.

[17] Rand R.J., Lowe J.W.: "L ow-grade endometrial sarcoma treated with a progestagen". Br. J. Hosp. Med., 1990, 43, 154.

[18] Chu M.C., Mor G., Lim C., Zheng W., Parkash V., Schwartz E.P "Low-grade endometrial stromal sarcoma: hormonal aspects". Gynecol. Oneal., 2003, 90, 170.

[19] Spano J.P., Soria J.C., Kambouchner M.,和perno-Neuman S., Morin F., Morere J.F. et al.: "Long term survival of patients given hormonal therapy for metastatic endometrial stromal sarcoma". Med. Oncol., 2003, 20, 87.

[20] Mesia A.F., Demopoulos R.I.: "Effects of leuprolide acetate in low-grade endometrial stromal sarcoma". Am. J. Obstet. Gynecol., 2000, 182, 1140.

[21] Scribiner D.R., Walker H.: "Low-grade endometrial stromal sacroma preoperative treatment with Depo-Lupron and Mecane". Gynecol. Oncol., 1998, 71, 458.

[22] Reich O., Regauer S.: "Is tamoxifen an option for patients with endometrial stromal sarcoma?". Gynecol. Oneal., 2005, 96, 561.