High-Intensity Focused Ultrasound (HIFU) as a Combined Approach for the Treatment of Recurrent Low-Grade Endometrial Stromal Sarcoma: A Case Report and Literature Review

Huihui Chen^1,2Xiaonan Shang²Yue Shen²Qingyi Wang¹Zhixing Cao³Peiyu Yan²Suying Xiao¹Liangyu Chen²Donghui Huang¹Min Kang^1,2*

• ¹Zhuhai City Hospital of Integrated Traditional Chinese and Western Medicine, Zhuhai, Guangdong Province, China
• ²Faculty of Chinese Medicine, Macau University of Science and Technology, Macau, Macau Region, China
• ³Zhuhai People's Hospital, Zhuhai, Guangdong Province, China

Background Surgery is the primary treatment for Endometrial Stromal Sarcoma (ESS), however, a substantial proportion of patients with ESS experience recurrence or metastasis. Currently, surgery and local ablation are the main treatments for recurrent ESS followed by chemotherapy, radiotherapy, immunotherapy, targeted therapy, and anti-estrogen therapy. Surgery and local ablation are invasive treatments and may carry risks such as intestinal damage and the risk of massive bleeding from tumor rupture. For patients who refuse or are unable to undergo surgery and local ablation, conservative treatment is not effective, and there is currently no definitive effective non-invasive or combined treatment plan. Case presentation This report presents a case of a patient with recurrent endometrial stromal sarcoma who refused surgical and local ablation treatments. After receiving HIFU treatment combined with chemotherapy, the progression of the tumor was effectively inhibited, the tumor volume significantly reduced, and liver function was restored during the HIFU period, providing an opportunity for chemotherapy. Conclusions HIFU combined with chemotherapy may provide a new treatment strategy for patients with recurrent, metastatic endometrial stromal sarcoma, or those who are unsuitable for surgery, local ablation, or those with poor baseline status unable to tolerate intensive chemotherapy.