Document Detail


Harm or benefit of hormonal treatment in metastatic low-grade endometrial stromal sarcoma: single center experience with 10 cases and review of the literature.
MedLine Citation:
PMID:  16368128     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Endometrial stromal sarcoma (ESS) is a rare disease with probably less than 700 new cases in the US or EU per year. ESS usually expresses steroidal receptors and is regarded to be hormone-sensitive. A higher risk in women receiving estrogen replacement therapy (ERT) or tamoxifen has been suspected, and remissions following treatment with progestins have been reported in case studies. Aromatase inhibitors represent an interesting new treatment option. Due to the rarity of the tumor, only few case series and no prospective studies are published. We therefore conducted a retrospective study to evaluate the influence of hormonal treatment to ESS. METHODS: Our institutional sarcoma data bank was screened for cases of ESS since 1999. All corresponding files and radiographs were reviewed retrospectively. RESULTS: Ten patients with low-grade ESS were identified. Diagnosis was established before or by hysterectomy in 6 patients, by local recurrence after previous hysterectomy for nonmalignant disease in 3 patients or by pulmonary metastases with no primary tumor found so far in 1 patient. 5/10 patients were on ERT and 3/10 on tamoxifen at the time of diagnosis of metastatic disease. Treatment strategies consisted of stopping ERT and tamoxifen, respectively, or initiation of the progestin MPA or letrozole. Three patients achieved stable disease after stopping ERT. 2/3 patients responded to MPA as first-line treatment (1 CR; 50+ months, 1 PR; 9 months). 4/5 patients responded to letrozole as first-line therapy (3 PR;3+, 9+ and 10+ months) or second-line treatment after MPA (1 PR; 37+ months). 9/10 patients are alive 33 to 255 months after hysterectomy. Survival since diagnosis of metastatic disease is 4 to 164 months. CONCLUSIONS: Patients with a previous history of low-grade ESS should not be treated with estrogens or tamoxifen. If nevertheless present, withdrawal of ERT or tamoxifen is strongly advised, resulting in disease stabilization in some cases. MPA and letrozole, in particular, are highly effective and lead to sustained disease control in most cases.
Authors:
Daniel Pink; Tanja Lindner; Alicia Mrozek; Albrecht Kretzschmar; Peter C Thuss-Patience; Bernd Dörken; Peter Reichardt
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Publication Detail:
Type:  Journal Article     Date:  2005-12-20
Journal Detail:
Title:  Gynecologic oncology     Volume:  101     ISSN:  0090-8258     ISO Abbreviation:  Gynecol. Oncol.     Publication Date:  2006 Jun 
Date Detail:
Created Date:  2006-05-25     Completed Date:  2006-06-27     Revised Date:  2009-11-19    
Medline Journal Info:
Nlm Unique ID:  0365304     Medline TA:  Gynecol Oncol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  464-9     Citation Subset:  IM    
Affiliation:
Medizinische Klinik mit Schwerpunkt Hämatologie, Onkologie und Tumorimmunologie, HELIOS-Klinikum Berlin-Buch, Robert-Rössle-Klink, Charité Campus Buch, Lindenberger Weg 80, D-13125 Berlin, Germany.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Antineoplastic Agents, Hormonal / adverse effects*,  therapeutic use*
Endometrial Stromal Tumors / drug therapy*,  pathology,  surgery
Estrogen Replacement Therapy / adverse effects*
Female
Humans
Medroxyprogesterone Acetate / adverse effects,  therapeutic use
Middle Aged
Nitriles / adverse effects,  therapeutic use
Pelvic Neoplasms / drug therapy,  surgery
Peritoneal Neoplasms / drug therapy,  surgery
Retrospective Studies
Tamoxifen / adverse effects,  therapeutic use
Triazoles / adverse effects,  therapeutic use
Uterine Neoplasms / drug therapy,  surgery
Chemical
Reg. No./Substance:
0/Antineoplastic Agents, Hormonal; 0/Nitriles; 0/Triazoles; 10540-29-1/Tamoxifen; 112809-51-5/letrozole; 71-58-9/Medroxyprogesterone Acetate
Comments/Corrections
Comment In:
Gynecol Oncol. 2006 Aug;102(2):413-4; author reply 414   [PMID:  16712906 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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