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(P 372) ESGO, EURACAN AND GCIG UTERINE SARCOMA GUDLINES: THE FIRST GLOBAL CONSENSUS

Objective: A collaboration was established between the European Society of Gynaecological Oncology (ESGO), the European Reference Network on Rare Adult Solid Cancers (EURACAN) and the Gynaecologic Cancer Inter Group (GCIG) with the aim to develop clinically relevant, evidence-based consensus guidelines on the management of patients with uterine sarcomas from diagnosis to relapse.

Methods: ESGO/EURACAN/GCIG selected expert clinicians from reference centers for patients with uterine sarcomas to serve as panelists (25 experts). A systematic literature search was carried out to avoid biases and levels of evidence accompanied all critical statements. The guidelines were finally reviewed by 104 independent international clinicians with expertise in uterine sarcomas from the communities joining this effort.

Results: Attention was given to imaging, pathology and molecular analyses, clinical management. Recommendations for surgery, including specific recommendations at initial diagnosis and at relapse, were developed, as well as for radiation therapy and systemic therapies, includingchemotherapy, endocrine therapies and targeted therapies, separating the following subgroups of uterine sarcomas: uterine leiomyosarcomas, high-grade endometrial stromal sarcomas, undifferentiated sarcomas, low-grade endometrial stromal sarcomas, adenosarcomas, very rare entities. Looking at the levels of evidence of crucial recommendations, divided into localized and advanced setting see table 1

Conclusion: This was an international consensus effort on a group of sarcomas which are rare or very rare and are followed by two different communities, i.e. the sarcoma and the gynaeco-oncology. This may help harmonize international practice. However, the levels of evidence backing the most crucial recommendations are definitely suboptimal, when evaluated according to usual pyramids of evidence. This obviously depends on the difficulties to undertake controlled trials in rare or vey rare cancers. We wish that this state-of-the-art effort may be translated into future research efforts on a similarly international basis.