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一名复发性子宫内膜间质肉瘤患者在接受多次手术切除和激素治疗后对依西美坦产生长期反应。

Prolonged response to exemestane following multiple surgical resections and hormonal therapies in a patient with recurrent endometrial stromal sarcoma.

作者信息

Wolfe Heather, Bunch Kristen, Stany Michael

机构信息

Walter Reed National Military Medical Center,Department of Obstetrics and Gynecology, United States.

Walter Reed National Military Medical Center,Department of Obstetrics and Gynecology,Division of Gynecologic Oncology, United States.

出版信息

Gynecol Oncol Rep. 2015 Aug 7;15:4-6. doi: 10.1016/j.gore.2015.07.008. eCollection 2016 Jan.

DOI:10.1016/j.gore.2015.07.008
PMID:26937477
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4750016/
Abstract

BACKGROUND

Endometrial stromal sarcomas (ESSs) are rare, indolent tumors with high recurrence rates. Management includes surgery and hormonal therapy given high estrogen and progesterone receptor (ER/PR) expression.

CASE

A pre-menopausal patient with stage II ESSs (ER +/PR +) underwent primary surgery followed by adjuvant megestrol. Recurrence in the bladder/upper vagina (ER +/PR -) was diagnosed one year later and treated with anterior pelvic exenteration and adjuvant letrozole. Two years later she recurred and was treated with radical surgery and adjuvant exemestane therapy (tumor ER strongly +/PR +). The patient then had a five-year disease free interval before being diagnosed with her third recurrence (ER +).

CONCLUSION

Exemestane treatment for ESSs can lead to a prolonged response, even in the setting of progression after prior aromatase inhibitor treatment.

摘要

背景

子宫内膜间质肉瘤（ESSs）是罕见的惰性肿瘤，复发率高。鉴于其高雌激素和孕激素受体（ER/PR）表达，治疗方法包括手术和激素治疗。

病例

一名患有II期ESSs（ER+/PR+）的绝经前患者接受了初次手术，随后接受了甲地孕酮辅助治疗。一年后诊断出膀胱/上阴道复发（ER+/PR-），并接受了前盆腔脏器清除术和来曲唑辅助治疗。两年后她再次复发，接受了根治性手术和依西美坦辅助治疗（肿瘤ER强阳性/PR+）。该患者随后有五年无病间隔期，之后被诊断为第三次复发（ER+）。

结论

依西美坦治疗ESSs可导致反应延长，即使在先期芳香化酶抑制剂治疗后病情进展的情况下也是如此。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/86d7/4750016/74c5bd67bb52/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/86d7/4750016/42818f3a0850/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/86d7/4750016/74c5bd67bb52/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/86d7/4750016/42818f3a0850/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/86d7/4750016/74c5bd67bb52/gr2.jpg

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本文引用的文献

1
Gynecologic Cancer InterGroup (GCIG) consensus review for endometrial stromal sarcoma.妇科肿瘤研究协作组（GCIG）关于子宫内膜间质肉瘤的共识综述。
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Treatment of hormone positive uterine leiomyosarcoma with aromatase inhibitors.芳香化酶抑制剂治疗激素阳性子宫平滑肌肉瘤
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Examestane in advanced or recurrent endometrial carcinoma: a prospective phase II study by the Nordic Society of Gynecologic Oncology (NSGO).
在晚期或复发性子宫内膜癌中使用依西美坦：北欧妇科肿瘤学会（NSGO）的一项前瞻性 II 期研究。
BMC Cancer. 2014 Feb 5;14:68. doi: 10.1186/1471-2407-14-68.
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Current and future options in the management and treatment of uterine sarcoma.子宫肉瘤管理与治疗的当前及未来选择
Ther Adv Med Oncol. 2014 Jan;6(1):21-8. doi: 10.1177/1758834013513314.
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Prognostic factors and outcomes in endometrial stromal sarcoma with the 2009 FIGO staging system: a multicenter review of 114 cases.2009 年 FIGO 分期系统中子宫内膜间质肉瘤的预后因素和结局：114 例多中心回顾性研究。
Gynecol Oncol. 2014 Jan;132(1):70-5. doi: 10.1016/j.ygyno.2013.10.029. Epub 2013 Oct 31.
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Hormonal treatment in recurrent and metastatic gynaecological cancers: a review of the current literature.复发性和转移性妇科癌症的激素治疗：对当前文献的回顾。
Curr Oncol Rep. 2013 Dec;15(6):541-8. doi: 10.1007/s11912-013-0343-3.
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Endometrial stromal sarcoma: a systematic review.子宫内膜间质肉瘤：系统评价。
Obstet Gynecol. 2013 Sep;122(3):676-83. doi: 10.1097/AOG.0b013e3182a189ac.
8
Exemestane: one part of the chemopreventive spectrum for ER-positive breast cancer.依西美坦：用于治疗 ER 阳性乳腺癌的化学预防谱的一部分。
Breast. 2013 Jun;22(3):225-37. doi: 10.1016/j.breast.2013.02.015. Epub 2013 Mar 25.
9
Endocrine therapy resistance: current status, possible mechanisms and overcoming strategies.内分泌治疗耐药：现状、可能机制和克服策略。
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10
Uterine sarcoma and aromatase inhibitors: Tom Baker Cancer Centre experience and review of the literature.子宫肉瘤与芳香化酶抑制剂：汤姆贝克癌症中心的经验及文献回顾。
Int J Gynecol Cancer. 2012 Jul;22(6):1006-12. doi: 10.1097/IGC.0b013e31825b7de8.