How is endometrial stromal sarcoma treated?

Endometrial stromal sarcoma is a disease that exists in the uterus. As the name suggests, it is a disease that occurs in women and is accompanied by irregular vaginal bleeding. It is also very easy to detect during examinations. Later treatment is mainly through Western medicine surgery. So, how is endometrial stromal sarcoma treated? What is the main method of treatment?

Western medicine treatment methods:

1. Surgical treatment

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

Scope of surgery: total abdominal hysterectomy, bilateral oophorectomy, and selective resection of pelvic and para-aortic lymph nodes.

Note: It is necessary to collect pelvic and abdominal washing fluid for cytological examination and thoroughly explore the diaphragm, greater net and upper abdomen.

(1) Low-grade endometrial stromal sarcoma

Scope of surgery: 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.

Cause: The tumor is a sex hormone-dependent tumor, and the secreted sex hormones may stimulate the growth of hidden tumors. It is also easy to infiltrate the paracervix, adnexae and cervix.

Patients with lung metastases underwent lobectomy.

(2) Highly malignant endometrial stromal sarcoma

It is easy to relapse 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: A regimen based on cisplatin (DDP) or ifosfamide (IFO 1.5 g/m2, once a day for 5 days, once every 3 weeks).

(2) Highly malignant endometrial stromal sarcoma: use IAP regimen (ifosfamide + ADM + cisplatin).

(3) Common solutions:

Cisplatin (DDP) 75 mg/m2, intravenous drip/intraperitoneal injection.

Epirubicin (EPI)-ADM 40-60 mg/m2, intravenous drip.

IAP regimen: ifosfamide (IFO) 4g/m2, intravenous drip (use mesna 0.8g/m2, intravenous injection at 0, 4, 8h).

ADM 30-40 mg/m2, intravenous drip.

1 day of chemotherapy, repeated every 3 weeks.

3. Radiotherapy

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

(1) Postoperative external irradiation:

A treatment plan needs to be formulated based on the situation of residual tumors and metastases 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 whole pelvic irradiation tumor dose is increased to 40Gy, and the central lead-blocking four-field irradiation is still 15Gy. 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) Intracavitary radiation:

Remote post-loading intracavitary radiotherapy was used preoperatively.

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.

4. Progestin-based drug therapy

Indications: Patients with progesterone receptor and estrogen receptor positive cells.

Note: It should be used for a long time, generally more than 1 year.

Commonly used drugs:

(1) Megestrol acetate: 160 mg orally, once a day, for long-term maintenance.

(2) Medroxyprogesterone acetate (MPA): 200 mg orally, once a day, for long-term maintenance.

(3) Hydroxyprogesterone caproate (17α-hydroxyprogesterone acetate): 500 mg intramuscular injection, once a day. After one month, change to 500 mg twice a week for maintenance, or change to the above oral medication for long-term maintenance.

For those with negative progesterone receptors, tamoxifen (tamoxifen 10 mg bid, po) is used first to increase the sensitivity of the tumor to progesterone drugs, and then medroxyprogesterone (MPA) or MA is used.

The above are some of the most common Western medicine methods for treating endometrial stromal sarcoma. From the treatment methods, we can also know that endometrial stromal sarcoma is a very serious disease and needs to be controlled by chemotherapy to have hope of being cured. At this time, what the patient can do is to trust the doctor, actively cooperate, keep calm and not be anxious, and have a good attitude.