How to treat endometrial stromal sarcoma

Endometrial stromal sarcoma requires timely treatment to avoid greater impact and harm to women's reproductive health, including surgical treatment. After surgical treatment, radiotherapy and chemotherapy should also be used as auxiliary treatments.

1. Surgery

For patients who have been diagnosed with uterine sarcoma, timely surgical treatment should be considered.

(1) Scope of surgery for low-grade endometrial stromal sarcoma: total hysterectomy and bilateral salpingo-oophorectomy, and ovarian preservation is not recommended. Even if extensive metastasis occurs, the lesion should be removed as completely as possible. Patients with lung metastases underwent lobectomy.

(2) Highly malignant endometrial stromal sarcoma is prone to recurrence after surgery. For patients in the advanced stage, palliative surgery can be performed to relieve symptoms, followed by postoperative adjuvant radiotherapy and chemotherapy.

2. Chemotherapy

(1) Low-grade endometrial stromal sarcoma is treated with a regimen based on cisplatin (DDP) or ifosfamide once every 3 weeks.

(2) IAP regimen (ifosfamide + ADM + cisplatin) is used for high-grade malignant endometrial stromal sarcoma.

3. Radiotherapy

Indications: patients with residual lesions after surgery, patients with stage I or above, and highly malignant endometrial stromal sarcoma.

(1) The treatment plan for postoperative external irradiation needs to be formulated according to the situation of residual tumor and metastasis after surgery. The field setting of postoperative external irradiation is roughly the same as that of postoperative preventive pelvic irradiation.

For example, if there is residual sarcoma in the central part of the pelvis, the irradiation dose to the whole pelvis is increased to 40 Gy, and the central lead-blocking four-field irradiation is still 15 Gy.

For large pelvic wall masses: after completing the whole pelvis and four-field irradiation, a reduced-field irradiation of 10 to 15 Gy can be performed.

Positive para-aortic lymph nodes: set up another field, with an irradiation dose of 45-55 Gy, 8.5 Gy per week, completed within 4-6 weeks.

When the range of the lesion exceeds the pelvic cavity, an additional field can be added in the upper abdomen. The irradiation field area is determined according to the range of the lesion, and the liver and kidneys need to be covered with lead shielding. If the range of lung metastases is small, external irradiation can be performed on the lung metastases.

(2) Remote post-loading intracavitary radiotherapy is used before intracavitary radiosurgery.

Dose: Based on the reference point (point A) of intracavitary radiotherapy for cervical cancer, 15 to 20 Gy is appropriate, and it is best to make the uterus receive an evenly distributed dose.

When there is residual sarcoma in the vaginal stump after surgery, after external whole pelvic irradiation, intracavitary radiation can be supplemented with pelvic four-field irradiation. The dose reference point is 0.3 cm below the mucosa. The total amount can be 24-30 Gy, which can be completed in 3-5 times with an interval of 4-7 days.