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Re: Query about low-grade endomterial stromal sarcomaFrom: Ilancheran (s2800002@singnet.com.sg)Wed Apr 30 09:07:16 1997
Dear Dr Malpani At 11:05 AM 4/28/97 -0500, you wrote: >This is for the gynecologic oncologists on this list - >please help ! A 32 year old surgeon underwent an >exploratory laparotomy ( planned myomectomy with >preop diagnosis of large subserous fibroid). At the time >of surgery, no plane of cleavage could be found. A frozen section >histopathology revealed low grade endometrial stromal >sarcoma. Pelvic lymph nodes were also positive for >metastases. It was decided to close the abdomen and >perform the definitive surgery at a later date by an >experienced gynecologic oncologist. >What are the therapeutic options available now ? >What is the definitive surgical treatment ? >What about adjuvant chemotherapy ? radiotherapy ? >Should the ovaries be preserved ? Is there are role >for a lymphadenectomy ? What is the overall prognosis ? > >Thanks a lot for your help ! > >Dr A N Malpani, MD > Low grade ESS is a slow growing tumour. Recurrences, which appear late and progress slowly, are predominantly in the pelvis, parametria,vagina and the bladder. Long time survival is the rule! but recurrences can occur 5-10 years later. Recommended treatment is THBSO and pelvic lymphaddenectomy. In the presence of positive pelvic nodes radiation should be given to the pelvis. Many of these tumours respond to high dose progestogens and I would recommend Megace 80 mg bd for as long as possible.Other toxic chemotherapy is not recommended This may also alleviate some of the menopausal symptoms. A. Ilancheran, MD,FRCOG
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