TY - JOUR
T1 - Italian consensus conference on management of uterine sarcomas on behalf of S.I.G.O. (Societa' italiana di Ginecologia E Ostetricia)
AU - Ferrandina, Gabriella
AU - Aristei, Cynthia
AU - Biondetti, Pietro Raimondo
AU - Cananzi, Ferdinando Carlo Maria
AU - Casali, Paolo
AU - Ciccarone, Francesca
AU - Colombo, Nicoletta
AU - Comandone, Alessandro
AU - Corvo', Renzo
AU - De Iaco, Pierandrea
AU - Dei Tos, Angelo Paolo
AU - Donato, Vittorio
AU - Fiore, Marco
AU - Franchi, M.
AU - Gadducci, Angiolo
AU - Gronchi, Alessandro
AU - Guerriero, Stefano
AU - Infante, Amato
AU - Odicino, Franco
AU - Pirronti, Tommaso
AU - Quagliuolo, Vittorio
AU - Sanfilippo, Roberta
AU - Testa, Antonia Carla
AU - Zannoni, Gian Franco
AU - Scambia, Giovanni
AU - Lorusso, Domenica
N1 - Copyright © 2020 Elsevier Ltd. All rights reserved.
PY - 2020/11
Y1 - 2020/11
N2 - 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.
AB - 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.
U2 - 10.1016/j.ejca.2020.08.016
DO - 10.1016/j.ejca.2020.08.016
M3 - Article
C2 - 32992154
VL - 139
SP - 149
EP - 168
JO - Eur. J. Cancer
JF - Eur. J. Cancer
SN - 0959-8049
ER -