Management of Uterine Sarcoma Annotated Bibliography

Introduction

Health disorders in women always present a serious concern to the medical professionals and to the society on the whole. The situation might become more complicated if the diagnosis is not made earlier. Several disorders confined to women are considered to be age related and associated with tumors which in the present context is Uterine Sarcoma.

This gynecological disorder is considered as a rare neoplasm that occurs in postmenopausal women. It was thought that a plethora of malignancies of the uterine body are endometrial carcinomas – where uterine sarcomas constitute only about 4%.For the efficient management of this disorder, there is a need to review the literature that focus on is clinical characteristics and the possible risk factors.

Main body

Study by Vrzic-Petronijevic et al. (2006).This study was based on presenting clinical and pathological features of uterine sarcomas, diagnostic procedures, treatment options and studying previous year’s cumulative survival rates. A total of 61 patients with uterine sarcoma were involved. They have employed standard operative procedures like hysterectomy with bilateral salpingooophorectomy.

Their analysis had shown that 43 of the patients were postmenopausal and their data was very much in agreement with the earlier survival rates of two, three and five years. They have described that patients found with obesity and hypertension may have possible link with endometrial cancers which are characteristic of uterine sarcoma and further added that postmenopausal abnormal bleeding was the key indicator for medical examination that helped them to establish the diagnosis.

They have suggested that preoperative pathophysiology might better help in understanding early metastases characteristic for uterine sarcomas. This study may indicate that metabolic and gynecological complaints need to be carefully evaluated and there is a need of regular yearly or frequent follow-up studies, especially in postmenopausal women with known risk factors present. Hence, it is a worth supporting article for uterine sarcoma investigations.

Study by Gadducci et al. (2008).This study has highlighted the importance of adjuvant chemotherapy because of poorly available supporting evidences in the literature. It has focused on a swiss study where the combination of ifosfamide (IFO) and doxorubicin (DOX) obtained better results in response rating system in advanced gynaecological sarcomas and in advanced soft tissue sarcomas of other sites. This study has also emphasized on surgical treatment options such as abdominal hysterectomy and bilateral salpingo-oophorectomy as standard treatment options. Next, it has indicated the role of pelvic and para-aortic lymphoadenectomy for carcinosarcoma, but not for leiomyosarcoma and undifferentiated endometrial sarcoma.

It has also suggested the role of lymphoadenectomy for the low –grade endometrial stromal sarcoma. This might mean that the lymphoadenectomy is exhibiting specificity for various sarcomas and need to be carefully chosen before recommending. Adjuvant pelvic radiotherapy has not much significant activity. Therefore, this study has mentioned the usefulness of various surgical and treatment options with some limitations for lymphoadenoctomy.However, this study may help in the management of uterine sarcoma.

Study by Livi et al. (2003).This research work was designed with the objective of studying correlation between treatment for uterine sarcoma with outcome, prognostic importance of pathology, and clinical parameters. A total of 141 patients with histologically defined uterine sarcoma were studied. They have classified patients as per the staging process set by FIGO. They have identified Stage I, II, III, and IV tumors in 71, 13, 31, and 26 patients, respectively. High, intermediate, low, and unspecified grade tumors were identified in 45, 14, 20, and 62 patients, respectively. Total abdominal hysterectomy (TAH) and bilateralsalpingo-oophorectomy were performed in 93 patients, debulking surgery in 12, hysterectomy only in 11, subtotal hysterectomy in 18, and biopsy only in 7.

From the statistical analysis, it was inferred that that stage and histology were considered as the dominant prognostic factors for uterine sarcoma. Their data further supports radical surgery and radical dose adjuvant external irradiation for stage I and radical surgery with radical dose adjuvant irradiation comprising both external beam radiotherapy(EBRT) and brachytherapy for stages II _ III, even in elderly patients. It indicates that radiotherapy has the potential to lessen the local recurrence rate but with no scope for prolonging the survival. Therefore, since this study appears to obtain large significant data it may help in the efficient management of various stages of uterine sarcoma through various surgical procedures.

Study by Lavie et al. (2008).This study has reported that women with breast cancer may be at an increased risk of uterine sarcoma. They have evaluated the association between the drug, tamoxifen use and the risk of developing uterine sarcomas and endometrial carcinomas in a large cohort study of women diagnosed with breast cancer in 1987-1988.A total of 1507 breast cancer cases were studied. 17 uterine cancers were observed in 875 tamoxifen users compared to 4 uterine cancers in 621 non-tamoxifen users.

These results indicate that tamoxifen use was associated with elevated risks of uterine cancer incidence and mortality. Therefore, it may indicate that women with breast cancer need to be cautious while choosing the therapeutic regimen involving tamoxifen combinations. Since this study gives direct information regarding the possible association of the drug tamoxifen with uterine sarcoma, it may appear very much reliable in the present description on the management of uterine sarcoma.

Study by Price et al. (1997).The subjects involved were those with recurrent or persistent disease following surgery and/or radiation, with advanced disease at diagnosis, and high-risk histology. They found that in patients when a combination of paclitaxel and carboplatin was administered intravenously, 63% o had significant reduction in the size of tumor masses, indicating the possible scope of this approach for endometrial cancer resistant to standard therapy.

Thererefore, this study has shed light on the important role of combination therapy involving carboplatin and paclitaxel.It has also suggested follow up study to further determine the duration of response and whether progression-free and overall survival are influenced by treatment with these drugs.

Since, endometrial cancer is closely associated with uterine sarcoma this study appears worth supporting in the efficient management of the later.Subesquent studies on combination therapies might strengthen this report.

Conclusion

Therefore, these studies may strongly indicate the significant progress achieved in the better management of uterine sarcoma by highlighting the involvement of treatment options and several risk factors.

Hence, it was concluded that these five reports were found to be very much significant in providing the essential clues to the management of Uterine sarcoma.

References

1. Vrzic-Petronijevic, S., Likic-Ladjevic, I., Petronijevic, M., Argirovic, R., Ladjevic, N. (2006). Diagnosis and surgical therapy of uterine sarcoma. Acta Chir Iugosl, 53, 67-72.
2. Gadducci, A., Cosio, S., Romanini, A., Genazzani ,A.R. Crit Rev Oncol Hematol. (2008). The management of patients with uterine sarcoma: a debated clinical challenge. Crit Rev Oncol Hematol, 65, 129-42.
3. Livi, L., Paiar, F., Shah, N., Blake, P., Villanucci, A., Amunni, G., Barca, R., Judson, I., Lodge, N., Meldolesi,E , Simontacchi, G., Piperno, G.,Gallardi, A., Scoccianti, S., Biti, G.P., Harmer, C.(2003). Uterine Sarcoma: Twenty-Seven Years of Experience. Int. J. Radiation Oncology Biol. Phys 57, 1366–1373.
4. Lavie, O., Barnett-Griness, O., Narod, S.A., Rennert, G. (2008). The risk of developing uterine sarcoma after tamoxifen use. Int J Gynecol Cancer, 18, 352-6.
5. Price, F.V., Edwards, R.P., Kelley, J.L., Kunschner, A.J., Hart, L.A. (1997). A trial of outpatient paclitaxel and carboplatin for advanced, recurrent, and histologic high-risk endometrial carcinoma: preliminary report. Semin Oncol, (5 Suppl 15), S15-78-S15-82.