Question

Uterine sarcoma:
Role of hormonal therapy.

Hint:

Hormonal therapy is most beneficial for hormone receptor-positive tumors, particularly low-grade endometrial stromal sarcomas.

Answer 1

Hormonal therapy may play a role in the management of certain subtypes of uterine sarcoma, particularly low-grade endometrial stromal sarcomas (ESS), which are hormone-sensitive.
Step 1: Indications for Hormonal Therapy:
1. Endometrial Stromal Sarcoma: Low-grade ESS often expresses estrogen receptors (ER) and progesterone receptors (PR), making it responsive to hormonal therapies such as progestins or aromatase inhibitors.
2. Relapsed or Metastatic Disease: Hormonal therapy is sometimes used in the management of recurrent or metastatic ESS after failure of conventional chemotherapy, aiming to slow tumor growth.
Step 2: Types of Hormonal Therapies:
1. Progestins: Drugs like medroxyprogesterone acetate (MP or megestrol acetate are commonly used in hormone-sensitive ESS.
2. Aromatase Inhibitors: These drugs, such as letrozole or anastrozole, are used to block estrogen production in postmenopausal women, particularly for estrogen receptor-positive tumors.
Step 3: Limitations:
Hormonal therapy is generally less effective for high-grade or aggressive uterine sarcomas, and its use is limited to tumors with known hormone receptor expression.