What adjuvant treatment would you offer a young woman with stage IB uterine mullerian adenosarcoma with sarcomatous overgrowth?

Uterine adenosarcomas are rare tumors composed of benign endometrial epithelia with malignant stroma. An over growth of the sacromatous component is found in 10-50% of these neoplasms and tumors with this histologic finding clearly have a more aggressive biologic behavior. I would counsel patients that even with early stage disease the risk of recurrence is high with these tumors. Though there is no clear evidence that adjuvant chemotherapy +/- radiation prolongs overall survival of patients a trend in improvement of overall survival is noted in retrospective studies.

Therefore, it is reasonable to discuss pros and cons of adjuvant therapy with patients- chemotherapy agents to consider include gemcitabine and docetaxel or doxorubicin. Genetic abnormalities including copy number alterations and mutations in oncogenes and tumor suppressors are reported in these tumors. Given the absence of a standard of care, when and if possible, enrollment of patients with this diagnosis in clinical trials matched to the molecular profile of their tumor should be considered.