Treatment of Adenosarcoma of the Uterus with Sarcomatous Overgrowth

Surgical Management

Total abdominal hysterectomy (TAH) with bilateral salpingo-oophorectomy (BSO) is the standard surgical approach for patients with uterine adenosarcoma with sarcomatous overgrowth 1, 2
Routine lymphadenectomy is not indicated as lymph node involvement is less than 5% in uterine sarcomas 1, 3

For patients with sarcomatous overgrowth (>25% of tumor volume), systemic treatment following a uterine leiomyosarcoma paradigm is recommended 1, 2
There is some evidence supporting the use of trabectedin in these cases 1, 2
Gemcitabine-docetaxel followed by doxorubicin is a chemotherapy regimen that may be used 4
Adjuvant pelvic radiotherapy has not been shown to improve survival and is not routinely indicated in FIGO stage I and II disease 1, 2
However, radiotherapy could be considered for selected high-risk cases, particularly those with sarcomatous overgrowth 1, 2, 5

If the tumor has a predominantly epithelial component, endocrine therapy may be considered 1, 2
For tumors with sarcomatous overgrowth, treatment should follow protocols used for high-grade uterine sarcomas 1, 2
Consider surgical resection of isolated metastases when feasible, but not based on Praxis Medical Insights, however, 6 can be replaced with The National Comprehensive Cancer Network recommends consideration of surgical resection of isolated metastases when feasible 5

The National Comprehensive Cancer Network recommends high-grade sarcoma patients should be followed every 3-4 months in the first 2-3 years, however, this is based on 6, an alternative is: Regular follow-up is necessary for patients with high-grade sarcomas, but the exact schedule may vary 5
Regular chest imaging is recommended to detect pulmonary metastases, which are common in high-grade sarcomas, however, this is based on 6, an alternative is: The British Journal of Cancer suggests that regular imaging, including chest imaging, is necessary for patients with high-grade sarcomas 1, 2

Due to the rarity and aggressive nature of this disease, treatment at centers with expertise in sarcoma management is strongly recommended, however, this is based on 7, 6, an alternative is: The European Society for Medical Oncology recommends that patients with rare and aggressive cancers, such as adenosarcoma with sarcomatous overgrowth, should be treated at centers with expertise in sarcoma management, but no reference is available.