Objective Gynecological sarcomas account for 3% of all gynecological malignancies and are associated with a poor prognosis. Due to the rarity and heterogeneity of gynecological sarcomas there is still no consensus on optimal therapeutic strategies. This study’s objective was to describe the treatment strategies used in patients with gynecological sarcomas in the primary course of disease.
Methods The German prospective registry for gynecological sarcoma (REGSA) is the largest registry for gynecological sarcomas in Germany, Austria and Switzerland. Primary inclusion criteria for REGSA are histological diagnosis of sarcoma of the female genital tract, sarcoma of the breast or uterine smooth muscle tumors of uncertain malignant potential (STUMP). We evaluated data of the REGSA registry on therapeutic strategies used for primary treatment from August 2015 to February 2021.
Results A total of 723 patients from 120 centers were included. Data on therapeutic strategies for primary treatment were available in 605 cases. Overall, 580 (95.9%) patients underwent primary surgery, 472 (81.4%) of whom underwent only hysterectomy. Morcellation was reported in 11.4% (n=54) of all hysterectomies. A total of 42.8% (n=202) had no further surgical interventions, whereas an additional salpingo-ophorectomy was performed in 54% (n=255) of patients. An additional lymphadenectomy was performed in 12.7% (n=60), an omentectomy in 9.5% (n=45) and intestinal resection in 6.1% (n=29) of all patients. Among 448 patients with available information, 21.4% (n=96) received chemo- or targeted therapies, more commonly as single-agent treatment than as drug combinations. Information about anti-hormonal treatment was available for 423 patients, among which 42 (9.9%) received anti-hormonal treatment, 23 (54.8%) of whom with low-grade endometrial stroma sarcomas. For radiotherapy, data of 437 patients were available, among which 29 (6.6%) patients underwent radiotherapy.
Conclusion Our study showed that treatment of patients with gynecologic sarcomas is heterogeneous. Further trials are needed along with more information on treatment modalities, therapy response and patient-reported outcomes to implement new treatment strategies.
- gynecologic surgical procedures
Data availability statement
Data are available upon reasonable request.
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Collaborators REGSA is a project of the North-Eastern German Society of Gynecological Oncology (working group Ovary and Uterus, NOGGO e.V.) and the AGO (“Arbeitsgruppe Gynaekologische Onkologie”)—Study Group. It is supported by the German “Kommission Ovar” and “Kommission Uterus” of the German working group Gynecological Oncology (AGO e.V.), the Austrian working group Gynecological Oncology (AGO Austria), the Charité Comprehensive Cancer Center (CCCC) and the German Alliance for chronic rare diseases (Achse). There are no competing interests associated with the collaborator groups.
Contributors JS is the principal investigator of the study, he initiated and developed the registry and played the leading role in this work and in manuscript writing. JS is guarantor. ER did the main work in data processing, cleansing and manuscript writing and is a subinvestigator for the best recruiting center (Institution 1 - Charité); KP has a leading role for REGSA registry and supervised this work. DZ was the statistican involved. The following authors are primary members of the steering committee of REGSA registry and or took part in its primary development: HP, DD, RC, PW, CK, AH, M-ZM, AM, GE, AGZ.The following authors are the main representatives of the best recruiting centers for REGSA registry: FB, TA, SB, SK, FH, JW, E-KE, MK, PB, MK, CM, UAU, MW, LT, CA, HS, LH, TL, KK, BM, DH, MP, BL, TK, UK and AF are representatives of the close interdisciplinary cooperation with the Charié Comprehensive Cancer Center and Sarkoma-Center and play an important role in patient recruitment.
Funding This study was funded by PharmaMar and Novartis.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.