Fertility-sparing management of low-grade endometrial stromal sarcoma

Analysis of an institutional series and review of the literature

Giuseppe Laurelli, Francesca Falcone, Cono Scaffa, Enrico M. Messalli, Maurizio Del Giudice, Simona Losito, Stefano Greggi

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Objective Low-grade endometrial stromal sarcoma (LG-ESS) is a rare malignancy, often occurring before menopause. There is no consensus regarding its optimal management. Total hysterectomy and bilateral salpingo-oophorectomy precludes future fertility and may thus be undesirable by women wishing to maintain their reproductive potential. However, experience of fertility-sparing management in LG-ESS is very limited. In this paper, the disease outcome is presented in six young women with LG-ESS conservatively treated by combined hysteroscopic resection and hormonal therapy. Study design From October 2009 to February 2013, at the Gynecologic Oncology Department of the National Cancer Institute of Naples, six women, with early-stage LG-ESS aged 18-40 years who desired childbearing and/or retaining their fertility, were enrolled into a pilot study of fertility-sparing management. Diagnosis of LG-ESS was made on specimens from hysteroscopic resection performed on a presumed benign lesion. All patients were planned to be treated with adjuvant megestrol acetate for two years. Hormonal therapy was started within 6 weeks from the hysteroscopic resection, with orally megestrol acetate at 40 mg daily, increasing gradually according to patient's tolerance to the recommended total dose of 160 mg daily. Results All patients were submitted to hysteroscopic resection in a one-step procedure. Five patients started megestrol acetate within 6 weeks from the hysteroscopic resection (one patient did not start hormonal therapy because of early pregnancy after the hysteroscopic resection). Hormonal therapy was well tolerated; one patient stopped megestrol acetate after 12 months because of self-supporting strong desire to conceive; the other four patients regularly completed the hormonal therapy. To date, all patients show no evidence of disease. Conclusions Although fertility-sparing management is not the current standard of care for young women with early-stage LG-ESS, our preliminary data are promising. Larger series with a longer follow-up are needed to further assess safety and efficacy of combined hysteroscopic resection and hormonal therapy.

Original languageEnglish
Pages (from-to)61-66
Number of pages6
JournalEuropean Journal of Obstetrics and Gynecology and Reproductive Biology
Volume195
DOIs
Publication statusPublished - Dec 1 2015

Fingerprint

Endometrial Stromal Tumors
Fertility
Megestrol Acetate
Therapeutics
National Cancer Institute (U.S.)
Ovariectomy
Standard of Care
Menopause
Hysterectomy
Safety

Keywords

  • Fertility preservation
  • Hormonal therapy
  • Hysteroscopic surgery
  • Management of low-grade endometrial stromal sarcoma

ASJC Scopus subject areas

  • Obstetrics and Gynaecology
  • Reproductive Medicine

Cite this

Fertility-sparing management of low-grade endometrial stromal sarcoma : Analysis of an institutional series and review of the literature. / Laurelli, Giuseppe; Falcone, Francesca; Scaffa, Cono; Messalli, Enrico M.; Del Giudice, Maurizio; Losito, Simona; Greggi, Stefano.

In: European Journal of Obstetrics and Gynecology and Reproductive Biology, Vol. 195, 01.12.2015, p. 61-66.

Research output: Contribution to journalArticle

@article{c89b38241e27484db2a72d31067182cf,
title = "Fertility-sparing management of low-grade endometrial stromal sarcoma: Analysis of an institutional series and review of the literature",
abstract = "Objective Low-grade endometrial stromal sarcoma (LG-ESS) is a rare malignancy, often occurring before menopause. There is no consensus regarding its optimal management. Total hysterectomy and bilateral salpingo-oophorectomy precludes future fertility and may thus be undesirable by women wishing to maintain their reproductive potential. However, experience of fertility-sparing management in LG-ESS is very limited. In this paper, the disease outcome is presented in six young women with LG-ESS conservatively treated by combined hysteroscopic resection and hormonal therapy. Study design From October 2009 to February 2013, at the Gynecologic Oncology Department of the National Cancer Institute of Naples, six women, with early-stage LG-ESS aged 18-40 years who desired childbearing and/or retaining their fertility, were enrolled into a pilot study of fertility-sparing management. Diagnosis of LG-ESS was made on specimens from hysteroscopic resection performed on a presumed benign lesion. All patients were planned to be treated with adjuvant megestrol acetate for two years. Hormonal therapy was started within 6 weeks from the hysteroscopic resection, with orally megestrol acetate at 40 mg daily, increasing gradually according to patient's tolerance to the recommended total dose of 160 mg daily. Results All patients were submitted to hysteroscopic resection in a one-step procedure. Five patients started megestrol acetate within 6 weeks from the hysteroscopic resection (one patient did not start hormonal therapy because of early pregnancy after the hysteroscopic resection). Hormonal therapy was well tolerated; one patient stopped megestrol acetate after 12 months because of self-supporting strong desire to conceive; the other four patients regularly completed the hormonal therapy. To date, all patients show no evidence of disease. Conclusions Although fertility-sparing management is not the current standard of care for young women with early-stage LG-ESS, our preliminary data are promising. Larger series with a longer follow-up are needed to further assess safety and efficacy of combined hysteroscopic resection and hormonal therapy.",
keywords = "Fertility preservation, Hormonal therapy, Hysteroscopic surgery, Management of low-grade endometrial stromal sarcoma",
author = "Giuseppe Laurelli and Francesca Falcone and Cono Scaffa and Messalli, {Enrico M.} and {Del Giudice}, Maurizio and Simona Losito and Stefano Greggi",
year = "2015",
month = "12",
day = "1",
doi = "10.1016/j.ejogrb.2015.09.041",
language = "English",
volume = "195",
pages = "61--66",
journal = "European Journal of Obstetrics, Gynecology and Reproductive Biology",
issn = "0028-2243",
publisher = "Elsevier Ireland Ltd",

}

TY - JOUR

T1 - Fertility-sparing management of low-grade endometrial stromal sarcoma

T2 - Analysis of an institutional series and review of the literature

AU - Laurelli, Giuseppe

AU - Falcone, Francesca

AU - Scaffa, Cono

AU - Messalli, Enrico M.

AU - Del Giudice, Maurizio

AU - Losito, Simona

AU - Greggi, Stefano

PY - 2015/12/1

Y1 - 2015/12/1

N2 - Objective Low-grade endometrial stromal sarcoma (LG-ESS) is a rare malignancy, often occurring before menopause. There is no consensus regarding its optimal management. Total hysterectomy and bilateral salpingo-oophorectomy precludes future fertility and may thus be undesirable by women wishing to maintain their reproductive potential. However, experience of fertility-sparing management in LG-ESS is very limited. In this paper, the disease outcome is presented in six young women with LG-ESS conservatively treated by combined hysteroscopic resection and hormonal therapy. Study design From October 2009 to February 2013, at the Gynecologic Oncology Department of the National Cancer Institute of Naples, six women, with early-stage LG-ESS aged 18-40 years who desired childbearing and/or retaining their fertility, were enrolled into a pilot study of fertility-sparing management. Diagnosis of LG-ESS was made on specimens from hysteroscopic resection performed on a presumed benign lesion. All patients were planned to be treated with adjuvant megestrol acetate for two years. Hormonal therapy was started within 6 weeks from the hysteroscopic resection, with orally megestrol acetate at 40 mg daily, increasing gradually according to patient's tolerance to the recommended total dose of 160 mg daily. Results All patients were submitted to hysteroscopic resection in a one-step procedure. Five patients started megestrol acetate within 6 weeks from the hysteroscopic resection (one patient did not start hormonal therapy because of early pregnancy after the hysteroscopic resection). Hormonal therapy was well tolerated; one patient stopped megestrol acetate after 12 months because of self-supporting strong desire to conceive; the other four patients regularly completed the hormonal therapy. To date, all patients show no evidence of disease. Conclusions Although fertility-sparing management is not the current standard of care for young women with early-stage LG-ESS, our preliminary data are promising. Larger series with a longer follow-up are needed to further assess safety and efficacy of combined hysteroscopic resection and hormonal therapy.

AB - Objective Low-grade endometrial stromal sarcoma (LG-ESS) is a rare malignancy, often occurring before menopause. There is no consensus regarding its optimal management. Total hysterectomy and bilateral salpingo-oophorectomy precludes future fertility and may thus be undesirable by women wishing to maintain their reproductive potential. However, experience of fertility-sparing management in LG-ESS is very limited. In this paper, the disease outcome is presented in six young women with LG-ESS conservatively treated by combined hysteroscopic resection and hormonal therapy. Study design From October 2009 to February 2013, at the Gynecologic Oncology Department of the National Cancer Institute of Naples, six women, with early-stage LG-ESS aged 18-40 years who desired childbearing and/or retaining their fertility, were enrolled into a pilot study of fertility-sparing management. Diagnosis of LG-ESS was made on specimens from hysteroscopic resection performed on a presumed benign lesion. All patients were planned to be treated with adjuvant megestrol acetate for two years. Hormonal therapy was started within 6 weeks from the hysteroscopic resection, with orally megestrol acetate at 40 mg daily, increasing gradually according to patient's tolerance to the recommended total dose of 160 mg daily. Results All patients were submitted to hysteroscopic resection in a one-step procedure. Five patients started megestrol acetate within 6 weeks from the hysteroscopic resection (one patient did not start hormonal therapy because of early pregnancy after the hysteroscopic resection). Hormonal therapy was well tolerated; one patient stopped megestrol acetate after 12 months because of self-supporting strong desire to conceive; the other four patients regularly completed the hormonal therapy. To date, all patients show no evidence of disease. Conclusions Although fertility-sparing management is not the current standard of care for young women with early-stage LG-ESS, our preliminary data are promising. Larger series with a longer follow-up are needed to further assess safety and efficacy of combined hysteroscopic resection and hormonal therapy.

KW - Fertility preservation

KW - Hormonal therapy

KW - Hysteroscopic surgery

KW - Management of low-grade endometrial stromal sarcoma

UR - http://www.scopus.com/inward/record.url?scp=84951727133&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84951727133&partnerID=8YFLogxK

U2 - 10.1016/j.ejogrb.2015.09.041

DO - 10.1016/j.ejogrb.2015.09.041

M3 - Article

VL - 195

SP - 61

EP - 66

JO - European Journal of Obstetrics, Gynecology and Reproductive Biology

JF - European Journal of Obstetrics, Gynecology and Reproductive Biology

SN - 0028-2243

ER -