title: Management of uterine adenosarcomas with and without sarcomatous overgrowth.
abstract: OBJECTIVE
  Uterine adenosarcomas (AS) are rare tumors composed of malignant stromal and benign epithelial components. We sought to evaluate the role of primary surgery, adjuvant treatments, and salvage therapies for patients with uterine adenosarcomas.
  
  
  METHODS
  We identified all patients diagnosed with AS from 1990 to 2009 at our institution. Patient demographics, surgical procedures, sites of metastatic disease, and histologic features (e.g., presence of sarcomatous overgrowth, and heterologous elements) were collected. Treatment regimens and survival outcomes were evaluated.
  
  
  RESULTS
  Thirty-one patients were evaluable for this study: 19 (61%) received up-front treatment at our institution and 12 (39%) received treatment for recurrent disease. Most of the up-front treated patients (15, 79%) were diagnosed with stage I disease and underwent hysterectomy (100%) with bilateral salpingo-oophorectomy (84%). Of the 19 patients treated at our institution from time of initial diagnosis, 5 (26%) patients recurred (median follow-up, 72.9 months; range, 3-154). In 5 patients with sarcomatous overgrowth (AS+SO), the 2-year progression-free and overall survival rates were both 20% versus 100% for 14 patients without sarcomatous overgrowth. Responses to systemic treatment of measurable disease were observed in patients with and without sarcomatous overgrowth, but no optimal treatment strategy could be identified for either groups.
  
  
  CONCLUSIONS
  Unlike AS without sarcomatous overgrowth, AS+SO is an aggressive disease with a high recurrence rate. In our series, no optimal adjuvant or systemic treatment strategy was identifiable but standard sarcoma chemotherapy regimens appear to have efficacy in both AS and AS+SO.
authors.affiliation: Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Tanner
authors.forename: Thomas
authors.initials: T
authors.lastname: Toussaint
authors.forename: Mario M
authors.initials: MM
authors.lastname: Leitao
authors.forename: Martee L
authors.initials: ML
authors.lastname: Hensley
authors.forename: Robert A
authors.initials: RA
authors.lastname: Soslow
authors.forename: Ginger J
authors.initials: GJ
authors.lastname: Gardner
authors.forename: Elizabeth L
authors.initials: EL
authors.lastname: Jewell
mesh_terms: D018195:Adenosarcoma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D012189:Retrospective Studies; D015996:Survival Rate; D014594:Uterine Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*