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Aromatase inhibitor therapy for endometrial stromal sarcoma — two-centre experience
Affiliations- Department of Oncology and Radiotherapy, Medical University of Gdansk, Poland
- Department of Gynecology, Oncology and Gynecologic Endocrinology, Medical University of Gdańsk, Poland
- Regional Center of Oncology COPERNICUS, Gdańsk, Poland
- Department of Pathology, Medical University of Gdańsk, Poland
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Abstract
Objectives: Endocrine therapy is the recommended systemic treatment for steroid receptor positive endometrial stromal
sarcoma (ESS). There is no current consensus on the optimal hormonal therapy for ESS. The literature offers several reports on advanced/recurrent/metastatic ESS patients treated with progestins, whereas data on the efficacy of aromatase inhibitors are scarce.
Material and methods: We retrospectively identified cases treated for ESS with aromatase inhibitors at our institutions. There were five patients with advanced or unresectable recurrent estrogen, progesterone and androgen receptor-positive ESS, treated with aromatase inhibitors: letrozole or anastrozole (at a daily dose of 2.5 mg and 1 mg, respectively), as first-line endocrine therapy in all but one case treated following progression with megestrol acetate.
Results: Disease stabilization was achieved in four cases (80%), including two with long-term progression-free survival
for up to 10 years attained under letrozole treatment, and one case after prior progestin treatment. During therapy, no
substantial toxicity was observed.
Conclusions: Aromatase inhibitors as first- or second-line endocrine treatment achieve disease control in most steroid
receptor positive ESS. Our series of cases is evidence of aromatase inhibitors efficacy as long-term endocrine treatment
option for ESS patients.
Abstract
Objectives: Endocrine therapy is the recommended systemic treatment for steroid receptor positive endometrial stromal
sarcoma (ESS). There is no current consensus on the optimal hormonal therapy for ESS. The literature offers several reports on advanced/recurrent/metastatic ESS patients treated with progestins, whereas data on the efficacy of aromatase inhibitors are scarce.
Material and methods: We retrospectively identified cases treated for ESS with aromatase inhibitors at our institutions. There were five patients with advanced or unresectable recurrent estrogen, progesterone and androgen receptor-positive ESS, treated with aromatase inhibitors: letrozole or anastrozole (at a daily dose of 2.5 mg and 1 mg, respectively), as first-line endocrine therapy in all but one case treated following progression with megestrol acetate.
Results: Disease stabilization was achieved in four cases (80%), including two with long-term progression-free survival
for up to 10 years attained under letrozole treatment, and one case after prior progestin treatment. During therapy, no
substantial toxicity was observed.
Conclusions: Aromatase inhibitors as first- or second-line endocrine treatment achieve disease control in most steroid
receptor positive ESS. Our series of cases is evidence of aromatase inhibitors efficacy as long-term endocrine treatment
option for ESS patients.
Keywords
endometrial stromal sarcoma; endocrine therapy; aromatase inhibitors
About this articleTitle
Aromatase inhibitor therapy for endometrial stromal sarcoma — two-centre experience
Journal
Issue
Article type
Research paper
Pages
607-610
Published online
2018-11-30
Page views
1667
Article views/downloads
1594
DOI
Pubmed
Bibliographic record
Ginekol Pol 2018;89(11):607-610.
Keywords
endometrial stromal sarcoma
endocrine therapy
aromatase inhibitors
Authors
Krystyna Serkies
Anna Abacjew-Chmyłko
Magdalena Wieczorek-Rutkowska
Rafał Pęksa
References (25)- Conklin C, Longacre T. Endometrial Stromal Tumors. Advances In Anatomic Pathology. 2014; 21(6): 383–393.
- Serkies K, Pawłowska E, Jassem J. Systemic therapy for endometrial stromal sarcomas: current treatment options. Ginekologia Polska. 2016; 87(8): 594–597.
- Seagle BL, Shilpi A, Buchanan S, et al. Low-grade and high-grade endometrial stromal sarcoma: A National Cancer Database study. Gynecologic Oncology. 2017; 146(2): 254–262.
- Reich O, Regauer S. Aromatase expression in low-grade endometrial stromal sarcomas: an immunohistochemical study. Mod Pathol. 2004; 17(1): 104–108.
- Roy M, Kumar S, Bhatla N, et al. Androgen Receptor Expression in Endometrial Stromal Sarcoma. International Journal of Gynecological Pathology. 2017; 36(5): 420–427.
- Feng W, Hua K, Gudlaugsson E, et al. Prognostic indicators in WHO 2003 low-grade endometrial stromal sarcoma. Histopathology. 2013; 62(5): 675–687.
- Alkasi Ö, Meinhold-Heerlein I, Zaki R, et al. Long-term disease-free survival after hormonal therapy of a patient with recurrent low grade endometrial stromal sarcoma: a case report. Archives of Gynecology and Obstetrics. 2008; 279(1): 57–60.
- Altman AD, Nelson GS, Chu P, et al. Uterine sarcoma and aromatase inhibitors: Tom Baker Cancer Centre experience and review of the literature. Int J Gynecol Cancer. 2012; 22(6): 1006–1012.
- Bréchot JM, Kamboucher M, Brauner M, et al. [Pulmonary metastases from endometrial stromal sarcoma may benefit from hormone therapy]. Rev Mal Respir. 2007; 24(1): 69–72.
- Dahhan T, Fons G, Buist M, et al. The efficacy of hormonal treatment for residual or recurrent low-grade endometrial stromal sarcoma. A retrospective study. European Journal of Obstetrics & Gynecology and Reproductive Biology. 2009; 144(1): 80–84.
- Ioffe YJ, Li AJ, Walsh CS, et al. Hormone receptor expression in uterine sarcomas: Prognostic and therapeutic roles. Gynecologic Oncology. 2009; 115(3): 466–471.
- Krauss K, Bachmann C, Hartmann JT, et al. Management of late recurrence of a low-grade endometrial stromal sarcoma (LGESS): treatment with letrozole. Anticancer Res. 2007; 27(5B): 3477–3480.
- Leunen M, Breugelmans M, Sutter PhDe, et al. Low-grade endometrial stromal sarcoma treated with the aromatase inhibitor letrozole. Gynecologic Oncology. 2004; 95(3): 769–771.
- Maluf FC, Sabbatini P, Schwartz L, et al. Endometrial stromal sarcoma: objective response to letrozole. Gynecol Oncol. 2001; 82(2): 384–388.
- Nakamura K, Nakayama K, Ishikawa M, et al. Letrozole as second-line hormonal treatment for recurrent low-grade endometrial stromal sarcoma: A case report and review of the literature. Oncol Lett. 2016; 12(5): 3856–3860.
- Pink D, Lindner T, Mrozek A, et al. Harm or benefit of hormonal treatment in metastatic low-grade endometrial stromal sarcoma: single center experience with 10 cases and review of the literature. Gynecol Oncol. 2006; 101(3): 464–469.
- Ryu H, Choi YS, Song IC, et al. Long-term treatment of residual or recurrent low-grade endometrial stromal sarcoma with aromatase inhibitors: A report of two cases and a review of the literature. Oncol Lett. 2015; 10(5): 3310–3314.
- Shoji K, Oda K, Nakagawa S, et al. Aromatase inhibitor anastrozole as a second-line hormonal treatment to a recurrent low-grade endometrial stromal sarcoma: a case report. Medical Oncology. 2010; 28(3): 771–774.
- Spano JP, Soria JC, Kambouchner M, et al. Long-term survival of patients given hormonal therapy for metastatic endometrial stromal sarcoma. Med Oncol. 2003; 20(1): 87–93.
- Sylvestre V, Dunton C. Treatment of Recurrent Endometrial Stromal Sarcoma with Letrozole: A Case Report and Literature Review. Hormones and Cancer. 2010; 1(2): 112–115.
- Tzakas E, Liu S, Todd RW, et al. Hormonal therapy with letrozole prior to surgical management of recurrent metastatic low-grade endometrial stromal sarcoma (LGESS). Journal of Obstetrics and Gynaecology. 2009; 29(8): 778–779.
- Wolfe H, Bunch K, Stany M. Prolonged response to exemestane following multiple surgical resections and hormonal therapies in a patient with recurrent endometrial stromal sarcoma. Gynecologic Oncology Reports. 2016; 15: 4–6.
- Yamaguchi M, Erdenebaatar C, Saito F, et al. Long-Term Outcome of Aromatase Inhibitor Therapy With Letrozole in Patients With Advanced Low-Grade Endometrial Stromal Sarcoma. International Journal of Gynecological Cancer. 2015; 25(9): 1645–1651.
- Yang K, Shin J, Jung J, et al. A Case of Metastatic Low-Grade Endometrial Stromal Sarcoma Treated with Letrozole after Ovarian Ablation by Radiotherapy. Cancer Research and Treatment. 2015; 47(4): 958–962.
- Thanopoulou E, Aleksic A, Thway K, et al. Hormonal treatments in metastatic endometrial stromal sarcomas: the 10-year experience of the sarcoma unit of Royal Marsden Hospital. Clinical Sarcoma Research. 2015; 5(1).
