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The routine use of progestins might be a good choice for patients with recurrent low-grade endometrial stromal sarcoma after definite surgery

Li, Yiu-Taia; Wang, Peng-Huib,c,d,e,*

Journal of the Chinese Medical Association: June 2019 - Volume 82 - Issue 6 - p 524
doi: 10.1097/JCMA.0000000000000105
Letter to the Editor
Open

aDepartment of Obstetrics and Gynecology, Kuo General Hospital, Tainan, Taiwan, ROC

bDepartment of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC

cDepartment of Obstetrics and Gynecology, National Yang-Ming University, Taipei, Taiwan, ROC

dInstitute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC

eDepartment of Medical Research, China Medical University Hospital, Taichung, Taiwan, ROC

Conflicts of interest: The authors declare that they have no conflicts of interest related to the subject matter or materials discussed in this article.

Received March 16, 2019; accepted March 16, 2019.

Address correspondence. Dr. Peng-Hui Wang, Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, 201, Section 2, Shi-Pai Road, Taipei 112, Taiwan, ROC. E-mail addresses: phwang@vghtpe.gov.tw; pongpongwang@gmail.com; or phwang@ym.edu.tw (P.-H. Wang).

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

We read the current topic entitled “Hormone therapy following surgery in low-grade endometrial stromal sarcoma: Is it related to a decrease in recurrence rate?” with interest.1 We have a little concern about the authors’ conclusion: hormone therapy after surgery should be considered a viable option to decrease the recurrent rate of low-grade endometrial stromal sarcoma (LG-ESS) in women. The excellent therapeutic outcome of the authors’ institute is worthy of applause. We would like to ask the authors to provide much more information about the current study and hope to provide a better care for the similar patients in the future.

According to the results from the authors, the disease limited to the uterus was 75.7% (28/37), and the rate of lymph node metastases was 8.1% (3/37), suggesting that the majority of the patients in the current study belonged to the FIGO 1 stage. The tumors were completely resected (en-block surgery, including at least total hysterectomy and bilateral salpingo-oophorectomy) in all patients. All hinted us that no residual tumor was found in all patients in the current study. However, there were 62.2% of patients (23/37) who had received different kinds of postoperative adjuvant therapy, including radiotherapy (n = 3), chemotherapy (n = 7), hormone therapy (n = 12), and combination of chemotherapy and hormone therapy (n = 1). We are wondering why so many patients needed postoperative adjuvant therapy. In addition, could the authors kindly provide the detailed information about the background of these 23 patients? Could they also tell us about the information of individual who was treated with radiotherapy, chemotherapy, hormone therapy, or combination?

In the text, there were 10 patients (27%) having recurrence.1 The authors also provided clinical data about these patients, including surgery plus chemotherapy (n = 2), surgery plus combination of chemotherapy and hormone therapy (n = 2), surgery plus combination of radiotherapy and hormone therapy (n = 2), surgery plus hormone therapy (n = 2), hormone therapy alone (n = 1), and lost (n = 1). The complete response rate of these recurrences was amazing up to 80% (8/10). We found that therapy containing at least hormone therapy or surgery was 70% and 80%, respectively. Therapy containing at least two components, surgery and hormone therapy, was 60%. It is interesting to find that one patient died after starting therapy. Based on the above-mentioned findings, could we have a suggestion that hormone therapy after surgery might be a viable option for women with recurrent LG-ESS?

Finally, is there any difference of recurrence pattern between women treated with and without lymphadenectomy? Although the current concept seems to be negative for the routine use of lymphadenectomy in the management of women with LG-ESS or FIGO 1A grade 1 endometrioid-type endometrial cancer,2–5 the authors’ data seemed to show the marginal benefits of lymphadenectomy on the decrease of recurrent rate of these patients (14.3% vs 46.7% in patients with and without lymphadenectomy, respectively, p = 0.058).1

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ACKNOWLEDGMENTS

This article was supported by grants from the Ministry of Science and Technology, Executive Yuan, Taiwan (MOST 106-2314-B-075-061-MY3) and Taipei Veterans General Hospital (V108C-085).

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REFERENCES

1. Comert GK, Turkmen O, Kar I, Yucel O, Kilic C, Boran N, et al. Hormone therapy following surgery in low-grade endometrial stromal sarcoma: is it related to a decrease in recurrence rate? J Chin Med Assoc. 2019; 82.
2. Lee WL, Lee FK, Wang PH. Hormone therapy and low-grade endometrial stromal sarcoma. J Chin Med Assoc. 2019; 82:445–6.
3. Mbatani N, Olawaiye AB, Prat J. Uterine sarcomas. Int J Gynaecol Obstet. 2018; 143Suppl 2. 51–8.
4. Horng HC, Wen KC, Wang PH, Chen YJ, Yen MS, Ng HT; Taiwan Association of Gynecology Systematic Review Group. Uterine sarcoma part II-uterine endometrial stromal sarcoma: the TAG systematic review. Taiwan J Obstet Gynecol. 2016; 55:472–9.
5. Li YT, Horng HC, Wang PH. The role of complete staging surgery for pure endometrioid-type endometrial cancer. J Chin Med Assoc. 2018; 81:663–4.
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