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Treatment strategies in patients with gynecological sarcoma: Results of the prospective intergroup real-world registry for gynecological sarcoma in Germany (REGSA-NOGGO RU1)
  1. Eva Roser1,
  2. Philipp Harter2,
  3. Dario Zocholl3,
  4. Dominik Denschlag4,
  5. Radoslav Chekerov1,
  6. Pauline Wimberger5,
  7. Christian Kurzeder6,
  8. Annette Hasenburg7,
  9. Mustafa-Zelal Muallem1,
  10. Alexander Mustea8,
  11. Guenter Emons9,
  12. A G Zeimet10,
  13. Felix Beck1,
  14. Tjadina Arndt1,
  15. Sara Y Brucker11,
  16. Stefan Kommoss11,
  17. Florian Heitz2,
  18. Julia Welz2,
  19. Eva-Katharina Egger8,
  20. Matthias Kalder12,
  21. Paul Buderath13,
  22. Maximilian Klar14,
  23. Christian Marth10,
  24. Uwe Andreas Ulrich15,
  25. Michael Weigel16,
  26. Lea Traub17,
  27. Christoph Anthuber18,
  28. Hans Strauss19,
  29. Lars Hanker20,
  30. Theresa Link5,
  31. Karol Kubiak21,
  32. Badrig Melekian22,
  33. Daniela Hornung23,
  34. Martin Pölcher24,
  35. Bjoern Lampe25,
  36. Thomas Krauß26,
  37. Ulrich Keilholz27,
  38. Anne Flörcken28,
  39. Klaus Pietzner1 and
  40. Jalid Sehouli1,27
  1. 1Department of Gynecology with Center for Oncological Surgery, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité Medical University, Berlin, Germany
  2. 2Department of Gynecology and Gynecological Oncology, Kliniken Essen-Mitte, Essen, Germany
  3. 3Institute of Biometry and Clinical Epidemiology, Charité-Universitaetsmedizin Berlin Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
  4. 4Department of Gynecology, Hochtaunus-Kliniken gGmbH, Bad Homburg, Germany
  5. 5Department of Obstetrics and Gynecology, University of Dresden, TU Dresden, Dresden Germany and National Center for Tumor Diseases (NCT/UCC), Dresden, Germany
  6. 6Department of Obstetrics and Gynecology, Universitätsspital Basel, Basel, Switzerland
  7. 7Department of Gynecology, University of Mainz, Mainz, Germany
  8. 8Department of Gynecology and Gynecological Oncology, Bonn University Hospital, Bonn, Germany
  9. 9Department of Gynecology and Obstetrics, University Medicine Goettingen, Goettingen, Germany
  10. 10Department of Obstetrics and Gynecology, Innsbruck Medical University, Innsbruck, Innsbruck, Austria
  11. 11Department of Women's Health, Tübingen University Hospital, Tuebingen, Germany
  12. 12Department of Gynecology and Obstetrics, University Clinic Gießen and Marburg, Marburg, Germany
  13. 13Department of Gynecology and Obstetrics, University Hospital of Essen, University of Duisburg-Essen, Essen, Germany
  14. 14Department of Gynecology and Obstetrics, University Medical Center Freiburg, Freiburg, Germany
  15. 15Department of Obstetrics and Gynecology, Martin Luther Hospital Berlin, Berlin, Germany
  16. 16Department of Obstetrics and Gynecology, Leopoldina Krankenhaus Schweinfurt, Schweinfurt, Germany
  17. 17Department of Obstetrics and Gynecology, Technische Universität Munich, Munich, Germany
  18. 18Department of Obstetrics and Gynecology, Klinikum Starnberg, Starnberg, Germany
  19. 19Department of Obstetrics and Gynecology, University of Halle (Saale), Halle, Germany
  20. 20Department of Obstetrics and Gynecology, University of Schleswig-Holstein, Luebeck, Germany
  21. 21Department of Obstetrics and Gynecology, St. Franziskus Hospital Münster, Muenster, Germany
  22. 22Department of Obstetrics and Gynecology, Marienkliniken Siegen, Siegen, Germany
  23. 23Department of Obstetrics and Gynecology, Vidiakliniken, Standort Diakonissenkrankenhaus, Karlsruhe, Germany
  24. 24Department of Gynecologic Oncology, Rotkreuzklinikum Munich, Munich, Germany
  25. 25Department of Obstetrics and Gynecology, Florence-Nightingale-Hospital, Kaiserswerther Diakonie, Duesseldorf, Germany
  26. 26Department of Obstetrics and Gynecology, Klinikum Passau, Passau, Germany
  27. 27Charité Comprehensive Cancer Center and German Cancer Consortium, Berlin, Germany
  28. 28Department of Hematology, Oncology, and Tumor Immunology, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
  1. Correspondence to Professor Jalid Sehouli, Department of Gynecology with Center for Oncological Surgery, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Virchow Campus Clinic, Charité Medical University, 13353 Berlin, Germany; jalid.sehouli{at}charite.de

Abstract

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.

  • gynecology
  • sarcoma
  • gynecologic surgical procedures

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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Footnotes

  • 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.