Endometrial high-grade stromal sarcoma

I hope you are all well.  We are searching for the optimal adjuvant therapy for a recently diagnosed woman with high grade endometrial stromal sarcoma.

BS is a healthy 56 y/o woman with good performance status recently diagnosed with stage IIIA endometrial stromal sarcoma, morphologically high grade; tumor was 12.5 x 11.5 x 10.5cm with 10mm myometrial invasion (of 10mm) with serosal involvement, washings negative, and 18 nodes negative.

We are interested in your opinions.

Thank you kindly,
David Gaffney

Response # 1:
Hi David,

Would suggest pelvic RT for local control, using traditional fields as our experience has been that they can recur in peritoneal and other sites, especially with the serosal involvement (like other high-grade sarcomas). Not sure about systemic therapy but might be worth looking for progesterone receptors as you could use these as adjuvant or at the time of relapse

Tony Fyles

Response # 2:
In France standard treatment is radiation therapy plus curiethapy
these patients are actually included in a randomized trial with 2 arms : adjuvant chemotherapy (adria plus ifos plus cddp) and radiotherapy versus radiotherapy alone after complete surgical excision for localized stage
best regards

Isabelle Ray-Coquard

Response # 3:
Chemotherapy based on SAKK regimen (ref Leyvraz S, Ann Oncol 1998) Ifosfamide 10 g/m2 over five days and doxorubicin: 90 mg/m2 over three days.

GM-CSF (5 micrograms/kg/day subcutaneously) 24 hours after chemotherapy and continued for 10 days.

best regards

Mauro Signorelli

Response # 4:
This is a  bit rotten, serosal involvement  but nodes negative and a  high grade tumour. Were ER PR done and  I guess will be negative
I don't think there is a  "right" answer  but i would favour giving sequential chemotherapy and radiation with 4 cycles carbo-paclitaxel and  EBRT but no VBT.
I have  no evidence base to support or refute this approach!
Nick Reed
Response # 5:
Risk is systemic/peritoneal; Most active combination is ifo-dox I guess; whether adj chemo will change prognosis is unclear however.

Hope it helps,

Frederic Amant

Response # 6:
I will recommend central pelvic radiotherapy, reducing fields from 45 Gy (central pelvis)to 54 Gy to peri-vaginal region (in 1.8 Gy Fx).

Kailash Narayan