Italian consensus conference on management of uterine sarcomas on behalf of S.I.G.O. (Societa' italiana di Ginecologia E Ostetricia).
Adenosarcoma
/ drug therapy
Anthracyclines
/ therapeutic use
Antineoplastic Agents
/ therapeutic use
Chemotherapy, Adjuvant
/ methods
Consensus
Dacarbazine
/ therapeutic use
Female
Humans
Hysterectomy
/ methods
Ifosfamide
/ therapeutic use
Italy
Lymph Node Excision
/ methods
Neoplasm Staging
/ methods
Radiotherapy, Adjuvant
/ methods
Sarcoma
/ drug therapy
Uterine Neoplasms
/ drug therapy
Diagnosis
Medical treatment
Radiotherapy
Surgery
Uterine sarcomas
Journal
European journal of cancer (Oxford, England : 1990)
ISSN: 1879-0852
Titre abrégé: Eur J Cancer
Pays: England
ID NLM: 9005373
Informations de publication
Date de publication:
11 2020
11 2020
Historique:
received:
01
06
2020
revised:
10
08
2020
accepted:
22
08
2020
pubmed:
30
9
2020
medline:
23
2
2021
entrez:
29
9
2020
Statut:
ppublish
Résumé
Uterine sarcomas are very rare tumours with different histotypes, molecular features and clinical outcomes; therefore, it is difficult to carry out prospective clinical trials, and this often results in heterogeneous management of patients in the clinical practice. We planned to set up an Italian consensus conference on these diseases in order to provide recommendations on treatments and quality of care in our country. Early-stage uterine sarcomas are managed by hysterectomy + bilateral salpingo-oophorectomy according to menopausal status and histology; lymphadenectomy is not indicated in patients without bulky nodes, and morcellation must be avoided. The postoperative management is represented by observation, even though chemotherapy can be considered in some high-risk patients. In early-stage low-grade endometrial stromal sarcoma and adenosarcomas without sarcomatous overgrowth, hormonal adjuvant treatment can be offered based on hormone receptor expression. In selected cases, external beam radiotherapy ± brachytherapy can be considered to increase local control only. Patients with advanced disease involving the abdomen can be offered primary chemotherapy (or hormonal therapy in the case of low-grade endometrial stromal sarcoma and adenosarcoma without sarcomatous overgrowth), even if potentially resectable in the absence of residual disease in order to test the chemosensitivity (or hormonosensitivity); debulking surgery can be considered in patients with clinical and radiological response. Chemotherapy is based on anthracyclines ± ifosfamide or dacarbazine. Palliative radiotherapy can be offered for symptom control, and stereotactic radiotherapy can be used for up to five isolated metastatic lesions. Treatment of uterine sarcoma should be centralised at referral centres and managed in a multidisciplinary setting.
Sections du résumé
BACKGROUND
Uterine sarcomas are very rare tumours with different histotypes, molecular features and clinical outcomes; therefore, it is difficult to carry out prospective clinical trials, and this often results in heterogeneous management of patients in the clinical practice.
AIM
We planned to set up an Italian consensus conference on these diseases in order to provide recommendations on treatments and quality of care in our country.
RESULTS
Early-stage uterine sarcomas are managed by hysterectomy + bilateral salpingo-oophorectomy according to menopausal status and histology; lymphadenectomy is not indicated in patients without bulky nodes, and morcellation must be avoided. The postoperative management is represented by observation, even though chemotherapy can be considered in some high-risk patients. In early-stage low-grade endometrial stromal sarcoma and adenosarcomas without sarcomatous overgrowth, hormonal adjuvant treatment can be offered based on hormone receptor expression. In selected cases, external beam radiotherapy ± brachytherapy can be considered to increase local control only. Patients with advanced disease involving the abdomen can be offered primary chemotherapy (or hormonal therapy in the case of low-grade endometrial stromal sarcoma and adenosarcoma without sarcomatous overgrowth), even if potentially resectable in the absence of residual disease in order to test the chemosensitivity (or hormonosensitivity); debulking surgery can be considered in patients with clinical and radiological response. Chemotherapy is based on anthracyclines ± ifosfamide or dacarbazine. Palliative radiotherapy can be offered for symptom control, and stereotactic radiotherapy can be used for up to five isolated metastatic lesions.
CONCLUSIONS
Treatment of uterine sarcoma should be centralised at referral centres and managed in a multidisciplinary setting.
Identifiants
pubmed: 32992154
pii: S0959-8049(20)30467-6
doi: 10.1016/j.ejca.2020.08.016
pii:
doi:
Substances chimiques
Anthracyclines
0
Antineoplastic Agents
0
Dacarbazine
7GR28W0FJI
Ifosfamide
UM20QQM95Y
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
149-168Commentaires et corrections
Type : ErratumIn
Informations de copyright
Copyright © 2020 Elsevier Ltd. All rights reserved.
Déclaration de conflit d'intérêts
Conflict of interest statement On behalf of all the authors, there are no conflicts of interest.