The treatment of uterine sarcoma

By | December 11, 2011

As more pathological types of uterine sarcoma, each type of different sensitivity to chemotherapy and radiotherapy, and uterine sarcoma, local recurrence and distant metastasis of early tendency to create difficulties for clinical treatment, and the small number of cases less so No treatment has been proven. Comprehensive literature review, treatment of uterine sarcoma based on surgery should be based on an integrated combination of radiotherapy and chemotherapy treatment, some patients can be combined with progestin therapy. But the treatment ineffective.
(A) the treatment of uterine sarcoma, surgery is the surgical treatment of the basic types of treatment for uterine sarcoma in patients at the same time help to understand the time range of tumor invasion, pathological stage, type and degree of differentiation, to determine the next treatment. I prefer the previous extent of surgery and of hysterectomy and bilateral salpingo oophorectomy. II, the broad lines the uterus, bilateral annex resection, and pelvic lymph node dissection. Such as the uterus has been spread, in addition to the removal of the outside I try to remove visible tumor. That extensive uterus, bilateral annex resection, pelvic and aortic lymph node dissection, or even omentum resection for the treatment of uterine sarcoma I, did not improve their survival rate. Pre-clinical tumor spread due to the transfer beyond the removal of more than outside, observed that lymph node metastasis of early uterine sarcoma is not uncommon. I, II uterine sarcoma patients of pelvic lymph nodes and (or) para-aortic lymph node metastasis rate was 20.0% -45. 0%, of which I was of the lymph node metastasis 35. 0% -45. 0% 0 Chen reported 9 patients with lymph node metastasis in patients I died of the disease, suggesting that lymph node metastasis of uterine sarcoma metastasis and blood just as important, and may precede metastasis. Therefore, it seems unnecessary to expand the scope of operation.
At present, tend to expand the scope of operation, ten bilateral salpingo hysterectomy and pelvic lymph node dissection for abdominal aortic surgery ten omentum. Reason may be as follows: the vast majority of uterine sarcoma to radiotherapy and chemotherapy less sensitive, so the net cut as much as possible during surgery. early stage uterine sarcoma with lymphatic and hematogenous spread, so early uterine sarcoma should also be pelvic surgery and aortic lymph node dissection; due to uterine malignant mullerian mixed tumors and highly malignant stromal sarcoma of the lymph node metastasis rate higher than the consensus currently is above two sarcoma lymph node dissection should be routinely, other histological types of sarcoma are based on clinical stage and other specific circumstances. omentum is a common metastatic sites of uterine sarcoma. line lymphadenectomy help clear lesions and guide surgery and further chemotherapy. Therefore, uterine sarcoma in patients with cytoreductive to the direction of development may, in addition to complete resection of the lesions, but also stressed that accurate pathologic staging in patients on treatment and prognosis significance.
Low-grade endometrial stromal sarcoma of low malignant potential though, the prognosis is good, but the extent of surgery should hysterectomy and two attachments removed. Should not be reserved for young patients with ovarian. Due to tumor invasion and easy attachment to the uterine and cervical involvement are not uncommon, the recurrence rate was also high, and for sex hormone-dependent tumors, such as to retain the ovaries, the secretion of sex hormones may stimulate the growth of occult tumors. Therefore, not easy to narrow the scope of the operation. Leiomyosarcoma in uterine fibroids (leiomyoma sarcoma variable) and the scope of the operation, in principle, should be hysterectomy and bilateral salpingo removed. As the naked eye is not easy in the early diagnosis of sarcoma, but also because the patients often young and not sterile uterine fibroids cystectomy and subsequently by the frozen section or paraffin section pathology was proved to be leiomyoma smooth muscle sarcoma. At this point, should be in the excision hysterectomy and bilateral annex. When the young patients, no education, an urgent desire for fertility, consider the line fibroids (including sarcoma) cystectomy, but must be based on the degree of malignancy of tumors, the boundary is clear, there are dollars myometrium and vascular or lymphatic invasion, etc. careful discretion. Retention of reproductive function should be regular follow-up.
(B) treatment of uterine sarcoma, radiation therapy
Highly malignant uterine sarcoma, prone to recurrence, metastasis, should be integrated with chemotherapy, radiotherapy, to improve the local control rate and reduce metastasis and improve the outcome. Due to uterine sarcoma is less sensitive to radiation, unless the patients with advanced tumors, generally not in favor of radiotherapy, but not laparotomy surgery, more sensitive to radiotherapy in patients with uterine sarcoma radiotherapy can be considered first, as in creating the necessary conditions for treatment . Postoperative radiotherapy, to be based on age, fertility requirements, residue, follow-up to determine the conditions, postoperative radiotherapy and postoperative radiation is divided into prophylactic irradiation. Confirmed residual tumor after surgery or pelvic and aortic lymph node metastasis often implemented in the postoperative radiotherapy. Moskovic other 17 patients after high dose radiation therapy of uterine sarcoma patients found that the recurrence of prolonged survival rate. Prophylactic pelvic irradiation, the use of drilling 60 or linear accelerator for pelvic irradiation in vitro methods. Residual tumor after irradiation and to be based on the case of metastases develop treatment programs. Hoffman and other 54 cases of uterine sarcoma were reviewed, that the lack of radiotherapy can prolong the patient's treatment. Overseas studies have shown that a more positive effect on chemotherapy of uterine malignant mixed Mullerian tumor of other histological types of uterine sarcoma, but also delayed tumor recurrence. Therefore, systemic chemotherapy should be treated as a comprehensive measure. Effective drugs are doxorubicin, cyclophosphamide gaze intently plastic, rubber triazene microphone, VCR, JI since the plaintiff, dactinomycin, cyclophosphamide different cool glue.
Although chemotherapy for uterine sarcoma is still in the exploratory stage, more advanced and progress for the period, net cut as much as possible of the lesion surgery, radiation therapy also inhibited the local recurrence, but subclinical uterine sarcoma metastasis and pelvic external diffusion is only dependent on systemic chemotherapy. Xiaohong uterine sarcoma and other summarized the use of the chemotherapy regimen, efficacy and indications. By the recurrence time, especially the presence of risk factors, such as advanced uterine sarcoma, the degree of tumor differentiation grade II uterine sarcoma and uterine malignant mixed Mullerian tumor, intraoperative radiotherapy also possible to reduce the high-dose radiotherapy after surgery caused by intestinal complications. Endometrial stromal sarcoma and uterine malignant mixed Mullerian tumor sensitivity to radiotherapy compared with uterine leiomyosarcoma strong.

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