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B N, V S. Exploring the Clinicopathological Diversity in Sarcomatous Transformations in the Uterus. Cureus 2024; 16:e62671. [PMID: 39036252 PMCID: PMC11258678 DOI: 10.7759/cureus.62671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 06/18/2024] [Indexed: 07/23/2024] Open
Abstract
Introduction Uterine sarcomas are a rare group of mesenchymal tumors. They originate either from the uterine smooth muscle or from the endometrial stroma. The spectrum of malignant uterine sarcomatous transformations includes leiomyosarcoma, low-grade endometrial stromal sarcoma (LG-ESS), high-grade endometrial stromal sarcoma (HG-ESS), undifferentiated uterine sarcoma, and carcinosarcoma. The purpose of this study is to determine the distribution of malignant uterine sarcomatous transformations, in relation to the patient's age, epidemiological aspects, and clinical features, and to analyze the different histological types of uterine sarcomas diagnosed at our institution and thereby to quantify their frequency and determine the most common histopathological subtype occurring in the population. Materials and methods This was a retrospective descriptive study of 21 cases of malignant uterine sarcomatous transformations, diagnosed in Saveetha Medical College, Chennai, between January 2019 and December 2022. Data was collected from the archives of the department of pathology and from the department of medical records in the hospital. The spectrum of uterine sarcomas was analyzed in relation to the patient's age, menopausal status, presenting symptoms, preoperative diagnosis, biopsy and frozen section reports wherever available, and histopathological reports with pathological staging. Results The most common age group in which uterine sarcoma was diagnosed was found to be 61-70 years. All 10 patients who were diagnosed with carcinosarcoma were aged 60 years, and all seven patients diagnosed with low-grade endometrial stromal sarcoma were less than 50 years of age. Most of the patients were postmenopausal females, except for one patient who was premenopausal. The most common histological variety found was carcinosarcoma, malignant mixed mullerian tumor (47.6%), followed by LG-ESS (33.3%), leiomyosarcoma (14.28%), and HG-ESS (4.7%). Conclusion Uterine sarcomas are an aggressive group of tumors having a very poor prognosis. Due to its rarity and histopathological diversity, there is a lack of consensus on the risk factors.
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Affiliation(s)
- Neelayadakshi B
- Department of Pathology, Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Sudha V
- Department of Pathology, Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
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Rizzo A, Pantaleo MA, Saponara M, Nannini M. Current status of the adjuvant therapy in uterine sarcoma: A literature review. World J Clin Cases 2019; 7:1753-1763. [PMID: 31417921 PMCID: PMC6692269 DOI: 10.12998/wjcc.v7.i14.1753] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 05/16/2019] [Accepted: 06/27/2019] [Indexed: 02/05/2023] Open
Abstract
Uterine sarcomas (US) are rare mesenchymal tumours accounting approximately for 3%–7% of all uterine cancers. Histologically, US are classified into mesenchymal tumours or mixed epithelial and mesenchymal tumours. The group of mesenchymal tumours includes uterine leiomyosarcoma (uLMS, 65% of cases), endometrial stromal sarcoma (ESS, 21%) – traditionally divided into low grade (LG-ESS) and high grade–undifferentiated uterine sarcoma (5%) and other rare subtypes such as alveolar or embryonal rhabdomyosarcoma. Despite the fact that several drugs demonstrated clinical activity in advanced or metastatic settings, the role of postoperative therapy in US remains controversial. In this review, we have summarised the current state of the art, including the chief trials on adjuvant treatment modalities in US, especially focusing on uLMS, LG-ESS and other rare histotypes.
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Affiliation(s)
- Alessandro Rizzo
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna 40138, Italy
| | - Maria Abbondanza Pantaleo
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna 40138, Italy
| | - Maristella Saponara
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna 40138, Italy
| | - Margherita Nannini
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna 40138, Italy
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Livi L, Paiar F, Meldolesi E, Simontacchi G, Amunni G, Barca R, Villanucci A, Scoccianti S, Piperno G, Biti G. Treatment of Uterine Sarcoma at the University of Florence from 1980-2001. TUMORI JOURNAL 2019; 91:139-43. [PMID: 15948541 DOI: 10.1177/030089160509100207] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose To correlate the treatment used in uterine sarcoma with outcome. The prognostic importance of pathology, clinical parameters and treatment are analyzed. Patients and methods Forty patients (median age, 59 years; range, 37-85) with histologically verified uterine sarcoma were identified from a database compiled at the University of Florence from 1980 to 2001. Patients were followed for a median of 54 months (range, 3 months to 10 years). Twenty-four patients had leiomyosarcoma, 12 patients had mixed mullerian tumors, and 3 patients had endometrial stromal sarcoma. Stage I, II, III and IV tumors were identified in 22, 2, 9 and 7 patients, respectively. High, intermediate, low and unspecified grade sarcoma occurred in 9, 4, 5 and 22 patients, respectively. Results At the time of analysis, 58% of patients had died and 42% were alive, with a median survival of 2 years from the initial diagnosis. Cause-specific survival for the entire group was 81%, 41% and 25% at 1, 3 and 5 years, respectively. In our series, univariate analysis for cause-specific survival did not demonstrate statistical significance for histology, grade, stage or age. There appeared to be a significant impact for postoperative radiotherapy in reducing local recurrence with a total dose higher than 50 Gy. Conclusions Our data favor treatment for uterine sarcoma with radical surgery plus irradiation, even in elderly patients.
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Affiliation(s)
- Lorenzo Livi
- Radiotherapy Department, Florence University, Florence, Italy.
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Etiz D, Garipağaoğlu M, Etiz EE, Köse FM, Kayikçioğlu F, Haberal A, Citak L, Cakmak A. Results of Postoperative Radiotherapy in the Treatment of 29 Uterine Sarcoma Patients. TUMORI JOURNAL 2018; 89:183-8. [PMID: 12841668 DOI: 10.1177/030089160308900215] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and background The objective of this study was to evaluate the results of surgery combined with postoperative radiotherapy (RT) in patients with uterine sarcoma in order to describe the patterns of relapse and to define prognostic factors. Methods We report on 29 patients with uterine sarcoma (US) treated from 1980 to 1995; 18 patients with primary tumors were treated with surgery and adjuvant irradiation, while 11 patients with local recurrences (LR) after previous surgical resection received only radiotherapy. We evaluated the influence of stage, histology, grade, menopausal status, total radiation dose and brachytherapy on survival. Histological diagnosis was leiomyosarcoma in 13 patients (44.8%), endometrial stromal sarcoma in 10 patients (34.5%), and mixed mesodermal tumors in six patients (20.7%). Fifteen patients presented with stage I-II disease, three with stage III, and 11 with local recurrences. External pelvic RT was administered to all patients, in five patients combined with brachytherapy. The mean total dose was 54 Gy (SE 1.78). Univariate and multivariate analyses were carried out. Results Overall survival (OS) for the stage I-III group was 61.1% at two years and 33.3% at five years (median 29 months, SE 13.79). Disease-free survival (DFS) was 55.6% at two years and 33.3% at five years. Median DFS was 26 months (SE 14.85). In LR cases, median OS was only 10 months (SE 4.5). Multivariate analysis demonstrated that stage was the only prognostic factor after RT for US. Conclusions These data suggest that postoperative and/or salvage RT has a questionable impact on disease-free and overall survival because of the lack of homogeneity of stages in the series reported in the literature; it has, however, acceptable late side effects. Prospective multicenter trials including a statistically evaluable number of patients are necessary to further clarify the role of RT treatment programs for US.
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Affiliation(s)
- Durmuş Etiz
- Department of Radiation Oncology, Osmangazi University, Faculty of Medicine, Eskişehir, Turkey.
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Zhan L, Tang J, Sun M, Qin C. Animal Models for Tuberculosis in Translational and Precision Medicine. Front Microbiol 2017; 8:717. [PMID: 28522990 PMCID: PMC5415616 DOI: 10.3389/fmicb.2017.00717] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 04/06/2017] [Indexed: 12/12/2022] Open
Abstract
Tuberculosis (TB) is a health threat to the global population. Anti-TB drugs and vaccines are key approaches for TB prevention and control. TB animal models are basic tools for developing biomarkers of diagnosis, drugs for therapy, vaccines for prevention and researching pathogenic mechanisms for identification of targets; thus, they serve as the cornerstone of comparative medicine, translational medicine, and precision medicine. In this review, we discuss the current use of TB animal models and their problems, as well as offering perspectives on the future of these models.
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Affiliation(s)
- Lingjun Zhan
- Key Laboratory of Human Disease Comparative Medicine, Ministry of HealthBeijing, China.,Institution of Laboratory Animal Sciences, Centre for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing, China.,Beijing Key Laboratory for Animal Models of Emerging and Reemerging InfectiousBeijing, China.,Beijing Engineering Research Center for Experimental Animal Models of Human Critical DiseasesBeijing, China.,Key Laboratory of Human Diseases Animal Model, State Administration of Traditional Chinese MedicineBeijing, China
| | - Jun Tang
- Key Laboratory of Human Disease Comparative Medicine, Ministry of HealthBeijing, China.,Institution of Laboratory Animal Sciences, Centre for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing, China.,Beijing Key Laboratory for Animal Models of Emerging and Reemerging InfectiousBeijing, China.,Beijing Engineering Research Center for Experimental Animal Models of Human Critical DiseasesBeijing, China.,Key Laboratory of Human Diseases Animal Model, State Administration of Traditional Chinese MedicineBeijing, China
| | - Mengmeng Sun
- Key Laboratory of Human Disease Comparative Medicine, Ministry of HealthBeijing, China.,Institution of Laboratory Animal Sciences, Centre for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing, China.,Beijing Key Laboratory for Animal Models of Emerging and Reemerging InfectiousBeijing, China.,Beijing Engineering Research Center for Experimental Animal Models of Human Critical DiseasesBeijing, China.,Key Laboratory of Human Diseases Animal Model, State Administration of Traditional Chinese MedicineBeijing, China
| | - Chuan Qin
- Key Laboratory of Human Disease Comparative Medicine, Ministry of HealthBeijing, China.,Institution of Laboratory Animal Sciences, Centre for Tuberculosis, Chinese Academy of Medical Sciences and Peking Union Medical CollegeBeijing, China.,Beijing Key Laboratory for Animal Models of Emerging and Reemerging InfectiousBeijing, China.,Beijing Engineering Research Center for Experimental Animal Models of Human Critical DiseasesBeijing, China.,Key Laboratory of Human Diseases Animal Model, State Administration of Traditional Chinese MedicineBeijing, China
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Annede P, Gouy S, Mazeron R, Bentivegna E, Maroun P, Petit C, Dumas I, Leary A, Genestie C, Lhommé C, Deutsch E, Morice P, Pautier P, Haie-Meder C, Chargari C. Optimizing Local Control in High-Grade Uterine Sarcoma: Adjuvant Vaginal Vault Brachytherapy as Part of a Multimodal Treatment. Oncologist 2017; 22:182-188. [PMID: 28174295 DOI: 10.1634/theoncologist.2016-0204] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 08/18/2016] [Indexed: 11/17/2022] Open
Abstract
PURPOSE The phase III European Organization for Research and Treatment of Cancer 55874 study has shown that external beam radiotherapy (EBRT) given as adjuvant treatment decreased locoregional recurrences from 40% to 20% in patients (pts) with localized uterine sarcomas (US). No data exist, however, on the place of brachytherapy (BT). MATERIAL AND METHODS We conducted a single-center retrospective analysis of pts receiving adjuvant BT of the vaginal vault based on the vaginal mold technique as part of their multimodal adjuvant treatment for a high-grade US from 1985 to 2015. Treatment characteristics, patterns of relapse, and toxicity were examined. RESULTS Median follow-up time was 5.5 years. A total of 98 pts with high-grade US were identified: 81 leiomyosarcomas and 17 undifferentiated sarcomas. Postoperative chemotherapy was delivered in 53 pts. Median dose of EBRT was 45 Gy in 25 fractions. High-dose rate, low-dose rate, and pulsed-dose rate techniques were used in 66, 31, and 1 pts, respectively. At last follow-up, six pts (6.1%) experienced a locoregional relapse as first event. The International Federation of Gynecology and Obstetrics stage and the tumor size were associated with a higher probability of local relapse. When focusing on pts with stage I-III disease, 5-year overall survival was 77% (95% confidence interval: 67%-87%) and 5-year survival without locoregional failure was 91% (83%-98%). Toxicities were mild to moderate, with only four acute grade 3 toxicities and two grade 3 late effects. CONCLUSION Vaginal vault BT as part of a multimodal adjuvant treatment was associated with a high locoregional control rate and with acceptable side effects in localized high-grade US. The Oncologist 2017;22:182-188Implications for Practice: This study suggests that an aggressive adjuvant treatment combining chemotherapy and pelvic external beam radiotherapy followed with a brachytherapy of the vaginal vault is associated with a high locoregional control rate and an acceptable toxicity rate in patients with high grade uterine sarcoma. Adding a brachytherapy boost could also allow deescalating the total dose of pelvic external beam radiotherapy, in order to decrease the side effects of adjuvant treatment in these patients without increasing the risk of local relapse. However, the prognosis remains determined by a high frequency of systemic relapses.
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Affiliation(s)
- Pierre Annede
- Brachytherapy Unit, Gustave Roussy, Villejuif, France
- Department of Radiotherapy, Gustave Roussy, Villejuif, France
| | - Sébastien Gouy
- Department of Surgery, Gustave Roussy, Villejuif, France
| | - Renaud Mazeron
- Brachytherapy Unit, Gustave Roussy, Villejuif, France
- Department of Radiotherapy, Gustave Roussy, Villejuif, France
- INSERM 1030, Gustave Roussy Cancer Campus, Villejuif, France
| | | | - Pierre Maroun
- Brachytherapy Unit, Gustave Roussy, Villejuif, France
- Department of Radiotherapy, Gustave Roussy, Villejuif, France
| | - Claire Petit
- Brachytherapy Unit, Gustave Roussy, Villejuif, France
- Department of Radiotherapy, Gustave Roussy, Villejuif, France
| | - Isabelle Dumas
- Brachytherapy Unit, Gustave Roussy, Villejuif, France
- Department of Radiotherapy, Gustave Roussy, Villejuif, France
| | - Alexandra Leary
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | | | - Catherine Lhommé
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - Eric Deutsch
- Department of Radiotherapy, Gustave Roussy, Villejuif, France
- INSERM 1030, Gustave Roussy Cancer Campus, Villejuif, France
- Université Paris-Sud, SIRIC SOCRATES, Faculté de Médecine, Le Kremlin-Bicetre, France
| | - Philippe Morice
- Department of Surgery, Gustave Roussy, Villejuif, France
- Université Paris-Sud, SIRIC SOCRATES, Faculté de Médecine, Le Kremlin-Bicetre, France
| | - Patricia Pautier
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - Christine Haie-Meder
- Brachytherapy Unit, Gustave Roussy, Villejuif, France
- Department of Radiotherapy, Gustave Roussy, Villejuif, France
- INSERM 1030, Gustave Roussy Cancer Campus, Villejuif, France
| | - Cyrus Chargari
- Brachytherapy Unit, Gustave Roussy, Villejuif, France
- Department of Radiotherapy, Gustave Roussy, Villejuif, France
- INSERM 1030, Gustave Roussy Cancer Campus, Villejuif, France
- Institut de Recherche Biomédicale des Armées, Brétigny-sur-Orge, France
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Orbital metastasis of endocervical stromal sarcoma: a rare tumor and an uncommon metastasis. MENOPAUSE REVIEW 2015; 13:356-8. [PMID: 26327880 PMCID: PMC4352913 DOI: 10.5114/pm.2014.47991] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 03/08/2014] [Accepted: 10/13/2014] [Indexed: 01/14/2023]
Abstract
Endocervical stromal sarcoma (ECSS) is a very rare uterine sarcoma. The most common presentation is pelvic mass and vaginal bleeding. The mainstay of treatment is surgery. There is no consensus on the adjuvant treatment. Relapses are usually in the pelvic and abdominal regions. To a lesser extent, lung, liver and bone metastases may be seen. A 46-year-old woman had total abdominal hysterectomy (TAH) with bilateral salpingo-oophorectomy (BSO) performed due to endometrial polyp and leiomyoma. Six months after the TAH-BSO, she was admitted to the hospital with cough and hemoptysis. A thoracic mass was detected, and a biopsy was done. The diagnosis was low-grade ECSS metastasis. One week after thoracotomy, she was admitted to the hospital with loss of vision in the left eye. An orbital mass was detected with magnetic resonance imaging. Endometrial and cervical pathology preparations were reassessed and were compatible with ECSS. We performed mammography, thorax, and abdomen and cranial imaging to rule out other malignancies that may cause lung and orbital metastasis. Partial remission was achieved with systemic chemotherapy and orbital radiotherapy. Orbital metastasis may be seen in ECSS patients. Although we have less knowledge about the choice of chemotherapeutic agents, ifosfamide and doxorubicin are effective in treating ECSS.
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Interiano RB, McCarville MB, Wu J, Davidoff AM, Sandoval J, Navid F. Pneumothorax as a complication of combination antiangiogenic therapy in children and young adults with refractory/recurrent solid tumors. J Pediatr Surg 2015; 50:1484-9. [PMID: 25783402 PMCID: PMC4758326 DOI: 10.1016/j.jpedsurg.2015.01.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 01/13/2015] [Accepted: 01/14/2015] [Indexed: 12/20/2022]
Abstract
PURPOSE Antiangiogenic agents show significant antitumor activity against various tumor types. In a study evaluating the combination of sorafenib, bevacizumab, and low-dose cyclophosphamide in children with solid tumors, an unexpectedly high incidence of pneumothorax was observed. We evaluated patient characteristics and risk factors for the development of pneumothorax in patients receiving this therapy. PATIENTS AND METHODS Demographics, clinical course, and radiographic data of 44 patients treated with sorafenib, bevacizumab and cyclophosphamide were reviewed. Risk factors associated with the development of pneumothorax were analyzed. RESULTS Pneumothorax likely related to study therapy developed in 11 of 44 (25%) patients of whom 33 had pulmonary abnormalities. Median age of patients was 14.7 years (range, 1.08-24.5). Histologies associated with pneumothorax included rhabdoid tumor, synovial sarcoma, osteosarcoma, Ewing sarcoma, Wilms tumor, and renal cell carcinoma. Cavitation of pulmonary nodules in response to therapy was associated with pneumothorax development (P<0.001). Median time from start of therapy to development of pneumothorax was 5.7 weeks (range, 2.4-31). CONCLUSION The development of cavitary pulmonary nodules in response to therapy is a risk factor for pneumothorax. As pneumothorax is a potentially life-threatening complication of antiangiogenic therapy in children with solid tumors, its risk needs to be evaluated when considering this therapy.
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Affiliation(s)
- Rodrigo B. Interiano
- Department of Surgery, St. Jude Children’s Research Hospital, Memphis, Tennessee 38105, USA,Department of Surgery, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee 38163, USA
| | - M. Beth McCarville
- Department of Radiological Sciences, St. Jude Children’s Research Hospital, Memphis, Tennessee 38105, USA,Department of Radiology, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee 38163, USA
| | - Jianrong Wu
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, Tennessee 38105, USA
| | - Andrew M. Davidoff
- Department of Surgery, St. Jude Children’s Research Hospital, Memphis, Tennessee 38105, USA,Department of Surgery, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee 38163, USA
| | - John Sandoval
- Department of Surgery, St. Jude Children’s Research Hospital, Memphis, Tennessee 38105, USA,Department of Surgery, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee 38163, USA
| | - Fariba Navid
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, TN 38105, USA; Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA.
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Hou HL, Meng MB, Chen XL, Zhao LJ, Zhu L, Zhang BL, Wang P. The prognosis factor of adjuvant radiation therapy after surgery in uterine sarcomas. Onco Targets Ther 2015; 8:2339-44. [PMID: 26357482 PMCID: PMC4559239 DOI: 10.2147/ott.s88186] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objective This retrospective study evaluated the role of adjuvant radiotherapy (AR) after surgery in patients with uterine sarcoma and analyzed the prognostic factors of local-regional failure-free survival (LRFFS) and overall survival (OS). Patients and methods A study of a total of 182 patients with uterine sarcoma was conducted between June 1994 and October 2014. Adjuvant radiotherapy was defined as postoperative external beam radiation to the pelvis (30–50 Gray/10–25 fractions at five fractions/week). The primary end point was LRFFS, and the secondary end point was OS. Kaplan–Meier curves were compared using the log-rank test. Cox regression analyses were used to determine prognosticators for LRFFS and OS. Results The median follow-up time of all patients was 75 months, with a 5-year LRFFS of 62.1%. The 2-year and 5-year LRFFS rates were longer for those who received AR than for those who did not receive AR (83.4% vs 70.3%; 78% vs 55.3%; P=0.013). The 5-year OS of all patients was 56.2%, and no significant differences were observed in the 2-year and 5-year OS rates between these two groups (82.7% vs 71.4%; 64.1% vs 51.7%; P=0.067). Importantly, in patients with leiomyosarcoma, the 2-year and 5-year LRFFS and OS rates were longer for those who received AR than for those who did not receive AR (P=0.04 and P=0.02 for the 2-year and 5-year LRFFS, respectively). Conclusion Patients with uterine sarcoma who were treated with AR after surgery demonstrated an improved LRFFS compared with those who were treated with surgery alone, especially those patients with leiomyosarcoma. Therefore, the role of personalized adjuvant radiation for patients with uterine sarcoma still requires further discussion.
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Affiliation(s)
- Hai-Ling Hou
- Department of Radiation Oncology, CyberKnife Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, People's Republic of China
| | - Mao-Bin Meng
- Department of Radiation Oncology, CyberKnife Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, People's Republic of China
| | - Xiu-Li Chen
- Department of Radiation Oncology, CyberKnife Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, People's Republic of China
| | - Lu-Jun Zhao
- Department of Radiation Oncology, CyberKnife Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, People's Republic of China
| | - Li Zhu
- Department of Radiation Oncology, CyberKnife Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, People's Republic of China
| | - Bai-Lin Zhang
- Department of Radiation Oncology, CyberKnife Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, People's Republic of China
| | - Ping Wang
- Department of Radiation Oncology, CyberKnife Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, People's Republic of China
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Literature review of outcomes and prevalence and case report of leiomyosarcomas and non-typical uterine smooth muscle leiomyoma tumors treated with uterine artery embolization. Eur J Obstet Gynecol Reprod Biol 2015; 191:130-7. [DOI: 10.1016/j.ejogrb.2015.05.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 05/06/2015] [Accepted: 05/19/2015] [Indexed: 12/11/2022]
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Clinical outcomes of women with recurrent or persistent uterine leiomyosarcoma. Int J Gynecol Cancer 2015; 24:1434-40. [PMID: 25248114 DOI: 10.1097/igc.0000000000000221] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES This study aimed to identify prognostic factors influencing the outcome of recurrent or persistent uterine leiomyosarcoma (ULMS). METHODS All patients with recurrent or persistent ULMS who underwent treatment at the participating institutions between January 2000 and December 2010 were identified from the tumor registry. The Kaplan-Meier method was used to generate overall survival data. Factors predictive of outcome were compared using the log-rank test and Cox proportional hazards model. RESULTS One hundred fifteen (68.8%) patients who had recurrent/persistent disease were identified, 40 (34.8%) had persistent disease, and 75 (65.2%) had a recurrence. Median follow-up time was 24.9 months. The 5-year postrelapse survival rate was 15% and was not significantly different between women with recurrent or persistent disease (16% vs 13%; P = 0.1). Variables identified affecting the 5-year postrelapse survival rate included low number of mitosis at the time of diagnosis (<25, 25% vs 5%; P = 0.002), time to relapse from original diagnosis (≤6 vs >6 months, 8% vs 22%; P = 0.003)), and surgical treatment (17% vs 12%; P = 0.01). Age, stage, chemotherapy at time of original diagnosis or at the time of relapse, site of recurrence, and single versus multiple sites of recurrence were not associated with survival. In a multivariate Cox regression model, only low number of mitosis (hazard ratio, 0.5; 95% confidence interval, 0.3-0.8, P = 0.02) was identified as a predictor of overall survival. CONCLUSIONS The prognosis of patients with recurrent/persistent ULMS is, in general, poor. Women who have low number of mitosis at the time of diagnosis seemed to have better postrelapse survival.
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Yu T, Kim HJ, Wu HG, Ha SW, Song YS, Park NH, Kim JW. Outcome analysis in patients with uterine sarcoma. Radiat Oncol J 2015; 33:29-35. [PMID: 25874175 PMCID: PMC4394066 DOI: 10.3857/roj.2015.33.1.29] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Revised: 01/23/2015] [Accepted: 02/10/2015] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To analyze the prognostic factors for survivals and to evaluate the impact of postoperative whole pelvic radiotherapy (WPRT) on pelvic failure in patients with uterine sarcoma treated with radical surgery. MATERIALS AND METHODS We retrospectively analyzed 75 patients with uterine sarcoma who underwent radical surgery with (n = 22) or without (n = 53) radiotherapy between 1990 and 2010. There were 23 and 52 patients with carcinosarcoma and non-carcinosarcoma (leiomyosarcoma, 22; endometrial stromal sarcoma, 25; others, 5), respectively. The median follow-up period was 64 months (range, 17 to 269 months). RESULTS The 5-year overall survival (OS) and pelvic failure-free survival (PFFS) of total patients was 64.2% and 83.4%, respectively. Multivariate analysis revealed that mitotic count (p = 0.006) was a significant predictor of OS. However, factors were not found to be associated with PFFS. On analyzing each of the histologic subtypes separately, postoperative WPRT significantly reduced pelvic failure in patients with carcinosarcoma (10.0% vs. 53.7%; p = 0.046), but not in patients with non-carcinosarcoma (12.5% vs. 9.9%; p = 0.866). Among the patients with carcinosarcoma, 4 patients (17%) had recurrence within the pelvis and 3 patients (13%) had recurrence in other sites as an initial failure, whereas among the patients with non-carcinosarcoma, 3 patients (6%) experienced pelvic failure and 13 patients (25%) experienced distant failure. CONCLUSION The most significant predictor of OS was mitotic count. Based on the improved PFFS after postoperative WPRT only in patients with carcinosarcoma and the difference in patterns of failure between histologic subtypes, optimal adjuvant treatment options should be offered to patients based on the risk of recurrence patterns.
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Affiliation(s)
- Tosol Yu
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Hak Jae Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Hong-Gyun Wu
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Whan Ha
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Yong-Sang Song
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Noh-Hyun Park
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Jae-Won Kim
- Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
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Fernandez G, Borràs SMI, Pérez VN, Guedea F. Treatment of pure uterine sarcoma at the Institut Català D'Oncologia. Rep Pract Oncol Radiother 2014; 18:153-8. [PMID: 24416547 DOI: 10.1016/j.rpor.2012.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Revised: 10/22/2012] [Accepted: 12/18/2012] [Indexed: 11/26/2022] Open
Abstract
AIM The aim of this retrospective study was to investigate the clinical and histopathological characteristics of the disease and treatment outcome of patients with pure uterine sarcomas. BACKGROUND Uterine sarcomas are especially rare tumours, comprising only 3-5% of uterine cancers. They are characterized by histopathological diversity, rapid clinical progression, and poor prognosis. Optimal management consists of complete surgical removal and adjuvant radiotherapy may improve the prognosis. MATERIALS AND METHODS All patients with pure uterine sarcoma histology treated at our centre, the Institut Català D'Oncologia in Barcelona Spain, between 2002 and 2010 were reviewed. RESULTS Records of 17 patients treated at our hospital over an 8-year period were obtained. Nine patients (53%) had leiomyosarcoma, 7 (41%) had endometrial stromal sarcoma, and 1 patient had unclassified sarcoma. All patients were treated with external beam radiation after surgical excision. Mean age was 62 years (range, 51-69 years). Of the 17 patients, 13 (76%) presented with stage I disease, 2 (12%) were stage II, and 2 (12%) stage III. The overall actuarial 2-year survival estimate was 82.5%. Two patients experienced local relapse. The 2-year local control rate was 90%. A total of 5 patients experienced either local or metastatic relapse. The 2-year progression free survival rate was 58%. CONCLUSION In our experience, combined treatment (surgery and adjuvant radiation therapy) is effective with acceptable side effects. Larger and multicenter studies are needed to assess treatment outcome for pure uterine sarcoma histology.
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Affiliation(s)
- Gonçalo Fernandez
- Radiation Oncology Department at the Instituto Português de Oncologia de Lisboa, Francisco Gentil, Portugal
| | - Susanna Marín I Borràs
- Radiation Oncology Department at the Institut Català d'Oncologia (ICO), Hospitalet de Belltvige, Barcelona, Spain
| | - Valentín Navarro Pérez
- Unidad de Investigación Clínica at the Institut Català d'Oncologia (ICO), Hospitalet de Belltvige, Barcelona, Spain
| | - Ferran Guedea
- Radiation Oncology Department at the Institut Català d'Oncologia (ICO), Hospitalet de Belltvige, Barcelona, Spain
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14
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Nguyen SKA, Wong F. Right atrial metastasis of uterine leiomyosarcoma causing obstructive shock. ACTA ACUST UNITED AC 2012; 19:e292-4. [PMID: 22876159 DOI: 10.3747/co.19.978] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Uterine leiomyosarcomas are rare tumours, and secondary cardiac metastases are even rarer. We present the case of a 56-year-old ethnic Chinese woman who was being treated with adjuvant pelvic radiation for uterine leiomyosarcoma when she presented with signs of right heart failure and shock. She was rapidly diagnosed with a solid mass attached to the tricuspid valve. Subsequent surgical resection revealed leiomyosarcoma metastasis. Metastases of uterine leiomyosarcoma to the heart are extremely rare, but clinicians should be aware of this phenomenon. Surgical resection, when feasible, can be associated with longer survival.
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Affiliation(s)
- S K A Nguyen
- BC Cancer Agency-Fraser Valley Centre, Surrey, BC
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15
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Genever AV, Abdi S. Can MRI predict the diagnosis of endometrial carcinosarcoma? Clin Radiol 2011; 66:621-4. [PMID: 21507390 DOI: 10.1016/j.crad.2011.02.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2010] [Revised: 01/26/2011] [Accepted: 02/28/2011] [Indexed: 11/17/2022]
Abstract
AIM To ascertain whether magnetic resonance imaging (MRI) can be used to suggest a diagnosis of endometrial carcinosarcoma. MATERIALS AND METHODS A retrospective imaging review was performed of the MRI images of 39 patients with endometrial carcinosarcoma. Anteroposterior and longitudinal dimensions of the uterus and measurement of the endometrial thickness were taken in the sagittal plane. The ratio of antero-posterior measurement to endometrial thickness was calculated. The same measurements were taken on 50 patients with endometrial adenocarcinoma. A two-tailed t-test and receiver operator characteristic analysis were performed on these measurements for both patient groups. RESULTS There was a statistically significant difference between the longitudinal (p=0.0084) and anteroposterior (p=0.00036) dimensions of the uterus of the two groups. There was also a statistically significant difference between the ratios of anteroposterior dimension to endometrial thickness (p=0.00018). The optimal cut-off ratio above which the radiologist should be alerted to a potential diagnosis of endometrial carcinosarcoma was shown to be 0.63. CONCLUSION MRI can be helpful in suggesting a diagnosis of endometrial carcinosarcoma with the help of some simple measurements.
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Affiliation(s)
- A V Genever
- Department of Radiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
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Hoag JB, Sherman M, Fasihuddin Q, Lund ME. A comprehensive review of spontaneous pneumothorax complicating sarcoma. Chest 2010; 138:510-8. [PMID: 20382720 DOI: 10.1378/chest.09-2292] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Spontaneous pneumothorax (SPTX) is an uncommon phenomenon in the general population and is most commonly associated with prior bulbous emphysema, cystic parenchymal lung disease, and tuberculous lung disease. A rare cause of SPTX is malignant disease, either in the form of primary lung or pleural cancers, or in metastatic disease to the lungs. The purpose of this investigation was to compile patient characteristics, treatments received, and outcomes of patients with SPTX complicating sarcomatous cancer. METHODS Case reports and series published in the medical literature were identified through a MEDLINE search and compiled to determine similarities among patient characteristics, treatments received, and outcomes. RESULTS One hundred fifty-three cases representing 20 different sarcoma cell types were included; 126 (82.3%) had received some form of treatment prior to the development of pneumothorax, and 70 (45.7%) experienced recurrence of pneumothorax at an average of 61 (+/- 112) days. Patients had poor survival, with only seven of 81 subjects remaining alive 2 years after the initial diagnosis of SPTX. CONCLUSIONS SPTX complicating sarcoma is associated with most cell types and is associated with increased mortality compared with patients without this complication.
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Affiliation(s)
- Jeffrey B Hoag
- Division of Pulmonary, Critical Care, and Sleep Medicine, Drexel University College of Medicine, NCB 12th Floor, Philadelphia, PA 19102, USA.
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17
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The Role of Adjuvant Radiation in Uterine Sarcomas. Int J Radiat Oncol Biol Phys 2010; 76:728-34. [DOI: 10.1016/j.ijrobp.2009.02.077] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2008] [Revised: 01/30/2009] [Accepted: 02/25/2009] [Indexed: 11/22/2022]
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18
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How to deal with prognostic factors and radiotherapy results in uterine neoplasms with a sarcomatous component? Clin Transl Oncol 2009; 11:681-7. [DOI: 10.1007/s12094-009-0424-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nugent EK, Zighelboim I, Case AS, Gao F, Thaker PH, Rader JS, Mutch DG, Massad LS. The value of perioperative imaging in patients with uterine sarcomas. Gynecol Oncol 2009; 115:37-40. [PMID: 19577795 PMCID: PMC4306556 DOI: 10.1016/j.ygyno.2009.06.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Revised: 06/01/2009] [Accepted: 06/10/2009] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To explore the yield and impact of perioperative imaging on management among patients undergoing surgical resection and treatment of uterine sarcomas. METHODS A retrospective chart review was done for women with histologically confirmed uterine sarcomas treated at Barnes Jewish Hospital/Washington University from 2001 to 2007. Descriptive statistics, Cox multivariate models, and Kaplan-Meier plots were used to evaluate associations and survival. RESULTS A total of 92 patients were identified and 55 (60%) were diagnosed with stage III-IV disease. Perioperative imaging was obtained in 84 (91%) cases, including chest X-ray in 66 (72%), computerized tomography (CT) of the abdomen and pelvis in 59 (64%), chest CT in 33 (36%), positron emission tomography (PET) in 8 (9%), and CT of the head, pelvic magnetic resonance imaging (MRI), or bone scan in a total of 2 (2.2%). Imaging identified abnormalities concerning for metastases in 30 (32%) studies. Thirty-four recurrences have been documented, and 21 (62%) of these treatment failures were extrapelvic. Multivariate analysis of this series noted that tomographic evidence of extrauterine disease predicted recurrence (p=0.028) and incomplete surgical resection (p=0.003, HR 6.0 95% CI 1.9-19.9) predicted disease-free survival. Imaging contributed to change in surgical and post-surgical treatment decisions in 8 (9%) patients. CONCLUSION Pretreatment imaging studies change management in a minority of patients with newly diagnosed uterine sarcomas.
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Affiliation(s)
- Elizabeth K Nugent
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine and Siteman Cancer Center, USA
| | - Israel Zighelboim
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine and Siteman Cancer Center, USA
| | - Ashley S Case
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine and Siteman Cancer Center, USA
| | - Feng Gao
- Division of Biostatistics, Washington University School of Medicine and Siteman Cancer Center, USA
| | - Premal H Thaker
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine and Siteman Cancer Center, USA
| | - Janet S Rader
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine and Siteman Cancer Center, USA
| | - David G Mutch
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine and Siteman Cancer Center, USA
| | - L Stewart Massad
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Washington University School of Medicine and Siteman Cancer Center, USA.
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21
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Leung F, Terzibachian JJ, Aouar Z, Govyadovskiy A, Lassabe C. Sarcomes utérins : aspects cliniques et histopathologiques. À propos de 15 cas. ACTA ACUST UNITED AC 2008; 36:628-35. [DOI: 10.1016/j.gyobfe.2008.03.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2007] [Accepted: 03/21/2008] [Indexed: 12/31/2022]
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22
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Fleming GF, Montag AC, Mundt AJ, Yamada S. Uterine Malignancies. Oncology 2007. [DOI: 10.1007/0-387-31056-8_53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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23
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Kim SH, Kim JW, Kim YT, Kim JH, Yoon BS, Ryu HS. Prognostic factors and expression of p53 and mdm-2 in uterine sarcomas. Int J Gynaecol Obstet 2006; 95:272-7. [PMID: 16930603 DOI: 10.1016/j.ijgo.2006.03.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2005] [Revised: 03/11/2006] [Accepted: 03/15/2006] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To evaluate the clinicopathologic prognostic factors of uterine sarcoma, and determine whether overexpression of p53 and mdm-2 proteins correlate with overall survival and prognostic factors. METHODS Thirty specimens from 43 patients with uterine sarcoma were available for slide review and evaluated by immunohistochemistry at Yonsei and Ajou University Medical Centers for the expression of p53 and mdm-2. RESULTS Overall survival was found to correlate to histologic type of uterine sarcoma, surgical stage, tumor grade, and mitotic index. Whereas 63% of the sarcomas expressed p53, with a significant correlation to overall survival, 60% expressed mdm-2, with a significant correlation to the mitotic index but not to overall survival. CONCLUSION Histologic type, surgical stage, tumor grade, mitotic index, and p53 expression were prognostic factors of the overall survival of patients with uterine sarcoma.
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Affiliation(s)
- S H Kim
- Department of Obstetrics and Gynecology, Women's Cancer Clinic, Institute of Women's Life Science, Yonsei University College of Medicine, Seoul, South Korea
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Kelly KLJ, Craighead PS. Characteristics and management of uterine sarcoma patients treated at the Tom Baker Cancer Centre. Int J Gynecol Cancer 2005; 15:132-9. [PMID: 15670308 DOI: 10.1111/j.1048-891x.2005.15014.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
The purpose of this study was to evaluate patients with uterine sarcoma from Southern Alberta to assess patterns of care and outcomes associated with treatment by a multidisciplinary team. Using the Alberta Cancer Registry database, charts of all uterine sarcoma patients treated between 1988 and 1997 in Southern Alberta were extracted. The majority of patients underwent definitive surgery. Adjuvant treatments were performed in selected patients at the discretion of the multidisciplinary tumor board. Demographics, management, and outcomes were collected into an electronic database. Eighty-seven patients were treated for uterine sarcoma at the Tom Baker Cancer Centre from 1988 to 1997. The 5-year overall survival rate was 48% and the 10-year overall survival rate was 21%. Univariate analysis demonstrated that stage, histologic subtype, and treatment with radiation therapy had a significant effect on local control and that stage and histologic subtype had a significant effect on survival. Stage was significant in the multivariate analysis for both local control (P = 0.008) and overall survival (P = 0.0001). Based on the findings in this series, stage remains a significant prognostic factor for patients with uterine sarcoma. Multidisciplinary care in the local setting reduced the use of adjuvant therapy without impacting adversely on survival or local control.
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Affiliation(s)
- K-L J Kelly
- Department of Radiation Oncology, Tom Baker Cancer Centre, 1331-29 Street NW, Calgary, Alberta T2N 4N2, Canada.
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Benoit L, Arnould L, Cheynel N, Goui S, Collin F, Fraisse J, Cuisenier J. The role of surgery and treatment trends in uterine sarcoma. Eur J Surg Oncol 2005; 31:434-42. [PMID: 15837053 DOI: 10.1016/j.ejso.2005.01.010] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2004] [Revised: 12/17/2004] [Accepted: 01/06/2005] [Indexed: 11/15/2022] Open
Abstract
AIMS To report a series of uterine sarcomas treated in one institution. METHODS We report 72 cases of uterine sarcomas treated in a single institution, comparing the periods 1966-1989 and 1990-2001. The parameters studied were histological type, tumour stage and treatment. The control of pelvic, local and/or metastatic disease were also studied. RESULTS The histological types consisted in 34 leiomyosarcomas, 25 mixte mullerian tumours, 12 endometrial stromal sarcoma and one angiosarcoma. The median age at diagnosis was 60.5 years. The presenting symptoms were genital bleeding, pelvic or abdominal pain. The proportion, of stage I was lower in 1966-1989 than in 1990-2002. During the 1966-1989 period, surgery was systematically used. The percentage of second-line surgery (post-radiotherapy or -chemotherapy) rose from 2.2% in 1966-1989 to 19.2% in 1990-2002. Radiotherapy was administered in 55.5% of cases. There was no difference between the two periods. Chemotherapy was administered in 37.5% of cases with also no difference between the two periods. The overall 2-year survival was 54.6% and the 5-year survival 36.1%. The median survival was 32.3 months (3 days-25 years). The overall 5-year survival by stage was 47.5% for stage I, 60.6% for stage II and 15.0% for stages III and IV. The median duration of pelvic disease control was 19.2 months. The 5-year pelvic disease control by FIGO stage was 66.6% for stage I, 62.5% for stage II and 18% for the more advanced stages. CONCLUSION Surgery remains the reference treatment. Local and regional disease control, as adjuvant therapies do not seem to decrease the risk of metastatic spread or increase survival.
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Affiliation(s)
- L Benoit
- Service de chirurgie digestive, thoracique et cancérologique, Hôpital du Bocage, CHU, Dijon, France.
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Thomas A, Agarwal S. Uterine sarcoma: an unusual metastatic site. J OBSTET GYNAECOL 2004; 19:90. [PMID: 15512238 DOI: 10.1080/01443619966128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- A Thomas
- Department of Urology, Hammersmith Hospital, London, UK
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Livi L, Andreopoulou E, Shah N, Paiar F, Blake P, Judson I, Harmer C. Treatment of uterine sarcoma at the Royal Marsden Hospital from 1974 to 1998. Clin Oncol (R Coll Radiol) 2004; 16:261-8. [PMID: 15214650 DOI: 10.1016/j.clon.2004.01.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
AIMS Uterine sarcomas are rare tumours with histopathological diversity characterised by rapid clinical progression and poor prognosis. Optimal management consists of complete surgical removal, but is not clear whether adjuvant radiotherapy improves the prognosis. The aim of this retrospective study was to investigate the clinical and histopathological characteristics together with treatment and outcome of patients with uterine sarcomas. MATERIALS AND METHODS Records of 100 patients treated at the Royal Marsden Hospital between 1974-1998 were reviewed: 47 leiomyosarcoma (LMS), 30 mixed mullerian tumours (MMT), 19 endometrial stromal sarcoma (ESS), one haemangiopericytoma, one rhabdomyosarcoma and two unspecified sarcoma. There were 50, 11, 21 and 18 patients with stage I, II, III and IV carcinoma, respectively. Thirty-four patients had high-grade disease. Fifty-three patients received adjuvant radiotherapy. The median age was 55 years (range: 18-83 years). The median follow-up was 54 months (range: 3 months to 27 years). RESULTS The overall 3, 5 and 10-year survival rates were 39%, 30% and 20%, respectively. Survival was significantly related to stage (P = 0.002), grade (P = 0.003) and histological type (P = 0.04), but not to use of postoperative irradiation. At 3 years, the survival rate was 42% for LMS, 22% for MMT and 63% for ESS. Local recurrence rate, however, was significantly improved after adjuvant radiotherapy with dose higher than 50 Gy (P = 0.001). CONCLUSIONS Prognosis is dependent on histopathological sub-type, grade and tumour stage. Adjuvant radiotherapy decreases local recurrence rate, but without significant impact on survival.
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Affiliation(s)
- L Livi
- Radiotherapy Department, Florence University, Florence, Italy
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Odunsi K, Moneke V, Tammela J, Ghamande S, Seago P, Driscoll D, Marchetti D, Baker T, Lele S. Efficacy of adjuvant CYVADIC chemotherapy in early-stage uterine sarcomas: results of long-term follow-up. Int J Gynecol Cancer 2004; 14:659-64. [PMID: 15304162 DOI: 10.1111/j.1048-891x.2004.14420.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Data on adjuvant chemotherapy in early-stage uterine sarcomas are conflicting and most often based on small patient groups with relatively short duration of follow-up. Approximately 60% of patients present with stage I disease with an overall 5-year survival of 30-50% when treated with surgery alone. This study examines the efficacy and results of long-term follow-up of a multiagent chemotherapy regimen of cyclophosphamide, vincristine, doxorubicin, and dacarbazine (CYVADIC) as adjuvant treatment for patients with stage I uterine sarcoma. Between 1982 and 1999, 24 evaluable patients with completely staged uterine sarcomas received adjuvant multiagent chemotherapy with vincristine sulfate (1mg /m(2)) on days 1 and 4, doxorubicin (40 mg /m(2)) and cyclophosphamide (400 mg /m(2)) on day 2, and dacarbazine (200 mg /m(2)) on days 1 through 4 for a total of nine monthly cycles or until recurrence of disease was documented. Survival distributions were calculated by the Kaplan-Meier method, and statistical significance was determined with the log-rank test. Factors significant on univariate analysis were analyzed in a multivariate fashion using Cox proportional hazards model. The histologic distribution of patients was 46% leiomyosarcoma, 33% mixed mullerian tumors, 13% stromal sarcomas, 4% adenosarcomas, and 4% hemangiosarcoma. The patients received 206 of a planned 216 cycles of chemotherapy. The median follow-up of the patient population was 93 months (range 11-213 months). Eight patients (33%) developed recurrent disease. The median time to recurrence was 19 months (range 7-184 months). The estimated survival for the entire group was 88, 75, and 69% at 2, 5, and 15 years, respectively. Factors that did not affect survival included age, histology, and tumor grade. Four patients required dose reductions secondary to grade 2-3 toxicities (hematologic). Grade 1 neurotoxicity was observed in six patients (25%) and grade 2 neurotoxicity in one patient (4%). Adjuvant CYVADIC chemotherapy appears to be safe and well tolerated in patients with stage I uterine sarcomas. Our data provide information on the longest duration of follow-up ever reported and suggests that CYVADIC may have a potential role in the adjuvant treatment of early-stage uterine sarcoma.
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Affiliation(s)
- K Odunsi
- Department of Gynecological Oncology, State University of New York at Buffalo, Buffalo, NY, USA
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Livi L, Paiar F, Shah N, Blake P, Villanucci A, Amunni G, Barca R, Judson I, Lodge N, Meldolesi E, Simontacchi G, Piperno G, Galardi A, Scoccianti S, Biti GP, Harmer C. Uterine sarcoma: twenty-seven years of experience. Int J Radiat Oncol Biol Phys 2004; 57:1366-73. [PMID: 14630275 DOI: 10.1016/s0360-3016(03)00750-8] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE A correlation of treatment for uterine sarcoma with outcome, prognostic importance of pathology, and clinical parameters. PATIENTS AND METHODS One hundred forty-one patients (median age: 56 years, range: 19-85 years) with a histologically verified uterine sarcoma were identified from a database compiled at the Royal Marsden Hospital and the University of Florence between 1974 and 2001. Seventy-two patients had leiomyosarcoma, 42 had mixed müllerian tumors, 22 had endometrial stromal sarcoma, 1 hemangiopericytoma, 1 rhabdomyosarcoma, and 3 patients had unspecified sarcoma. According to FIGO classification, Stage I, II, III, and IV tumors were identified in 71, 13, 31, and 26 patients, respectively. RESULTS At the time of analysis, 73.7% of patients were dead, and 26.3% were alive with a median survival of 2 years from initial diagnosis. Univariate analysis for cause-specific survival demonstrated statistical significance for histology (p = 0.02), grade (p = 0.003), stage (p = 0.007), and age (p = 0.02). Multivariate analysis demonstrated significant prognostic values for stage (p = 0.02) and histology (p = 0.05) only. Postoperative radiotherapy with a total dose higher than 50 Gy seems to be significant (p = 0.001) in reducing local recurrence. CONCLUSIONS Our data favor treatment for Stages I, II, and III of uterine sarcoma with radical surgery plus radical dose irradiation comprising both external beam radiotherapy and brachytherapy.
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Affiliation(s)
- L Livi
- Department of Radiotherapy, University of Florence, Florence, Italy.
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El Husseiny G, Al Bareedy N, Mourad WA, Mohamed G, Shoukri M, Subhi J, Ezzat A. Prognostic factors and treatment modalities in uterine sarcoma. Am J Clin Oncol 2002; 25:256-60. [PMID: 12040283 DOI: 10.1097/00000421-200206000-00010] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The aim of this study was to identify the impact of various prognostic factors in the management of uterine sarcoma. Fifty-nine patients with uterine sarcoma were treated at King Faisal Specialist Hospital and Research Center between 1980 and 1997. Forty-three patients (73%) were treated by total abdominal hysterectomy and bilateral salpingo-oophorectomy, 7 (12%) total abdominal hysterectomy and bilateral salpingo-oophorectomy with sampling of pelvic lymph nodes, and 9 (15%) had biopsy only. Nine patients received adjuvant treatment; five had radiation therapy (XRT), two had chemotherapy, one had combined XRT and chemotherapy, and one received hormonal treatment. Leiomyosarcoma cases accounted for 42% of all the uterine sarcomas, carcinosarcoma cases for 34%, and endometrial stromal sarcoma (ESS) for 24%. Fifty (85%) patients had pathologic grade II and III tumor, with only 9 patients grade I. Twenty-seven patients (46%) were classified surgically as stage I, 7 (12%) as stage II, 17 (29%) as stage III, and 8 (13%) had stage IV tumor. Recurrences developed in 34 patients (71%). The 5- and 10-year overall actuarial survival for all patients was 42%, and the corresponding relapse-free survivals for those who achieved complete response after primary treatment (48 patients) were 27% and 20%. On the univariate analysis, grade I tumors (p = 0.04), ESS (p = 0.02), nonmetastatic stage (p = 0.05), and negative peritoneal cytology (p = 0.04) were associated with better overall survival. Factors associated
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Affiliation(s)
- G El Husseiny
- Department of Radiation Oncology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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Deniaud-Alexandre E, Chauveinc L, de la Rochefordière A, Sastre X, Clough KB. [Role of adjuvant therapy in uterine sarcoma: experience of the Curie Institute]. Cancer Radiother 2001; 5:743-9. [PMID: 11797295 DOI: 10.1016/s1278-3218(01)00133-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Uterine sarcoma is a rare disease and survival is poor. From 1975 to 1995, 73 uterine sarcomas were treated at the Curie Institute, and we analysed prognostics factors of survival. PATIENTS AND METHODS Seventy-one patients underwent primary surgery, in most cases a radical non conservative surgery and a lymphadenectomy. Every patient had an irradiation (external beam irradiation and/or brachytherapy), and 24 patients received adjuvant chemotherapy. We observed that youngest patients had more leiomyosarcomas and low histologic grade tumours. Median survival was 42 months, and 5-years survival and local control were 36 and 68% respectively. Pelvic recurrences were most often before 2 years. This series demonstrates the impact of adjuvant irradiation on local control. This impact was stronger if the tumour had a high histologic grade (p < 0.01). However, irradiation, as well as chemotherapy, had no impact on the survival. CONCLUSION The study confirmed that irradiation enable a better local control. However modalities of radiation therapy (brachytherapy and/or external beam radiotherapy, dose, volume), are still controversed.
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Affiliation(s)
- E Deniaud-Alexandre
- Service de radiothérapie, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
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Weitmann HD, Knocke TH, Kucera H, Pötter R. Radiation therapy in the treatment of endometrial stromal sarcoma. Int J Radiat Oncol Biol Phys 2001; 49:739-48. [PMID: 11172957 DOI: 10.1016/s0360-3016(00)01369-9] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The efficacy of radiation therapy in the treatment of endometrial stromal sarcoma (ESS) is still not clear. We report our results over an 18-year period in comparison to data from literature concerning adjuvant radiation therapy and other treatment modalities. PATIENTS AND METHODS During 1981-1998, 21 patients with ESS were treated at General Hospital Vienna. The age of the patients ranged between 44-76 years (median: 65 yr). The 1989 FIGO classification for endometrial carcinoma was used in this study retrospectively. Eleven patients presented in Stage I, 1 in Stage II and 5 in Stage III. Four patients had Stage IV tumors or recurrences. The majority of patients (66.7%) had a Grade 3 tumor. Seventeen patients were treated in a curative intent. Fifteen patients were referred for postoperative radiotherapy after hysterectomy. Thirteen of them received a combined radiotherapy. Two patients were referred for primary radiotherapy. They received a combined radiotherapy. Four patients were referred for radiotherapy with a palliative intent. Twenty patients received external beam therapy (EBT) in daily fractions of 1.6-2.0 Gy up to a total dose of 27-57 Gy to the pelvis. Seventeen patients received brachytherapy. RESULTS Follow-up was 8 to 170 months (mean: 70.3 months, median: 64 months). Eleven patients are still alive, 10 without tumor and 1 with tumor. Ten patients are dead, 6 due to ESS, 1 due to breast cancer, and 3 due to intercurrent diseases. After adjuvant radiotherapy, 3 patients had tumor recurrences. All had distant metastases, and 1 had local failure additionally. Two patients with primary treatment died due to intercurrent disease without tumor. The overall actuarial survival and the disease-specific survival rates were 63.4% and 80.9% after 5 years and 52.8% and 80.9% after 10 years. The overall local control rate was 93.8% after 5 years. Four patients treated with a palliative intent showed partial response. Three patients died rapidly due to tumor. One patient with a Grade 1 tumor is still alive 12 months after treatment. CONCLUSION In our experience, surgery and adjuvant radiation therapy are most effective treatments for patients with ESS due to the excellent local control in all stages and the good disease-specific survival in early stages.
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Affiliation(s)
- H D Weitmann
- Department of Radiotherapy and Radiobiology, University of Vienna at the General Hospital Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
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Knocke TH, Weitmann HD, Kucera H, Kölbl H, Pokrajac B, Pötter R. Results of primary and adjuvant radiotherapy in the treatment of mixed Müllerian tumors of the corpus uteri. Gynecol Oncol 1999; 73:389-95. [PMID: 10366465 DOI: 10.1006/gyno.1999.5400] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The benefit of primary or adjuvant irradiation in the treatment of mixed Müllerian tumors is still not clear. METHODS During 1981-1997 63 patients were referred for primary (n = 13) or postoperative (n = 50) radiotherapy. Analysis of outcome of primarily and postoperatively irradiated patients was performed separately because of different staging systems. Of 50 patients treated after surgery 29 presented in histopathologic stage I, 4 in stage II, 14 in stage III, and 3 in stage IV. Clinical stage distribution for primary treatment was stage I: n = 9, stage II: n = 1, stage III: n = 3. Forty-four patients in the postoperatively treated group and 6 in the primarily treated group received radiotherapy with a curative intent; external beam therapy was given up to 56 Gy to the pelvis combined with intravaginal or intracavitary brachytherapy. RESULTS Five-year actuarial overall survival, disease-specific survival, local control, and distant control for 50 patients receiving adjuvant irradiation was 52.9, 57. 5, 83.4, and 70.8%, in stage I: 68.4, 76.1, 95.2, and 81.7%, in stage II: 50.0, 50.0, 75.0, and 66.7%, and in stage III: 31.3, 34.1%, 70.4, and 47.6%, respectively. Four of 13 patients treated with primary irradiation achieved long-term local control. CONCLUSION These data suggest that adjuvant radiotherapy improves local control and disease specific survival in the treatment of mixed Müllerian tumors compared to data in the literature concerning treatment by surgery alone.
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Affiliation(s)
- T H Knocke
- Department of Radiotherapy and Radiobiology, University of Vienna at the General Hospital Vienna, Vienna, 1190, Austria
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Ferrer F, Sabater S, Farrús B, Guedea F, Rovirosa A, Anglada L, Delannes M, Marín S, DuBois JB, Daly-Schveitzer N. Impact of radiotherapy on local control and survival in uterine sarcomas: a retrospective study from the Grup Oncologic Català-Occità. Int J Radiat Oncol Biol Phys 1999; 44:47-52. [PMID: 10219793 DOI: 10.1016/s0360-3016(98)00515-x] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE In order to provide more information for the clinician and to analyze the impact of radiation therapy on the loco-regional disease-free interval (LRFI), disease-free interval (DFI) and specific overall survival (OS), a multicentric retrospective study of uterine sarcomas has been undertaken using cases reported to the Grup Oncològic Català-Occità (GOCO). PATIENTS AND METHODS One hundred three patients were selected for this study with a median follow-up period of 49 months. Patients were restaged using the FIGO classification for endometrial adenocarcinoma. Radiotherapy was administered postoperatively to the entire pelvis in 52% of cases (54/103) and was combined with brachytherapy in 24 patients. Mean given dose was 48 Gy, with a 95% confidence interval of 45 to 50 Gy. Variables have been tested for homogeneity between hospitals. Univariate and multivariate analyses have also been carried out. RESULTS Mean age of the selected patients was 59 years (range 35-84). Stages were distributed as follows: 66 patients (64%) in Stage I; 16 in Stage II (15.5%); 12 in Stage III (11.5%); 9 patients in Stage IVa (9%). Pathological distribution was 41.5% leiomyosarcoma, 39% mixed Mullerian tumours, 16.5% stromal sarcomas, and 2.9% of a miscellaneous group. Overall survival for the entire group was 63.7% and 56% at 2 and 5 years, respectively. Probability of LRFI reached 59.8% at 2 years and 57.4 at 5 years. The DFI at 2 and 5 years were 52.9 % and 48.7%, respectively. The LRFI probability was 41% and 36% at 2 and 5 years, respectively, without radiotherapy and reached 76% at 2 and 5 years among those patients treated with radiotherapy. There was also an increase in DFI probability because of the effect of radiotherapy, from 35% to 68.5% and from 33% to 53% at 2 and 5 years, respectively. The overall survival probability for patients treated with radiotherapy was 76% and 73% at 2 and 5 years, respectively and 51% at 2 years and 37% at 5 years without radiotherapy. Multivariate analysis demonstrated that radiotherapy improved LRFI, DFI, and overall survival. CONCLUSION We conclude that postoperative radiotherapy in our series of patients diagnosed with uterine sarcoma has an impact on loco-regional and disease-free progression intervals and survival.
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Affiliation(s)
- F Ferrer
- Department of Radiotherapy, Hospital Clínic i Universitari, Barcelona, Spain.
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Chauveinc L, Deniaud E, Plancher C, Sastre X, Amsani F, de la Rochefordiere A, Rozemberg H, Clough KB. Uterine sarcomas: the Curie Institut experience. Prognosis factors and adjuvant treatments. Gynecol Oncol 1999; 72:232-7. [PMID: 10021306 DOI: 10.1006/gyno.1998.5251] [Citation(s) in RCA: 63] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE With a retrospective study at a single institution, we propose to analyze the prognosis factors and adjuvant treatment for uterine sarcomas. MATERIALS AND METHODS From 1975 to 1995, 73 uterine sarcomas were treated at the Institut Curie, corresponding to 61 T1, 5 T2, and 8 T4 tumors. Thirteen patients had metastatic disease at the time of diagnosis. The mean age was 58 years. In 71% of patients, the presenting sign was bleeding. This series consisted of 44% leiomyosarcomas (LMS), 19% endometrial stromal sarcomas (ESS), and 31% carcinosarcomas or mixed mesodermal sarcomas (MMS). For the grading classification, we used the classification of the Sarcoma Group of the French Federation of Cancer Centres for soft tissue sarcomas. Of the patients, 66% presented a high-grade tumor. RESULTS The median overall survival was 42 months, with a 5-year survival of 45%. Histological grade, FIGO stage, histology types, and menopausal status were the four independent factors in multivariate analysis. Eighteen patients relapsed locally (25.7%), with 77% central pelvic sites. Patients with radiotherapy and ESS had better local control in multivariate analysis. Thirty-four patients developed metastases (48.6%), mainly pulmonary (58.8%). Eight patients presented with peritoneal disease. High grades and LMS had the worst survival without metastasis in multivariate analysis. CONCLUSION This study validated our classification for sarcoma grading and confirmed the finding of worst prognosis for LMS and the importance of radiotherapy in local control.
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Affiliation(s)
- L Chauveinc
- Radiotherapy A, Institut Curie, Paris, France
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Abstract
BACKGROUND The role of radiotherapy in the treatment of uterine sarcoma still is not clear. Data from the literature advocating adjuvant radiotherapy most often are based on very small patient groups, whereas larger epidemiologic studies, which appear to show no benefit for the additional radiotherapy, lack information regarding clinical data influencing the choice for adjuvant irradiation. METHODS During 1981-1992, 72 patients were referred for postoperative radiotherapy. Histologic diagnoses were leiomyosarcoma (LMS) in 30 patients, endometrial stromal sarcoma (ESS) in 11 patients, mixed müllerian tumors (MMT) in 28 patients, and other sarcoma types in 3 patients. The 1988 International Federation of Gynecology and Obstetrics classification for endometrial carcinoma was applied retrospectively. Forty patients presented with Stage I disease, 9 with Stage II, 17 with Stage III, and 6 with Stage IV. External beam therapy was given with a cobalt-60 unit using a rotation technique with 2 separate arcs in daily fractions of 2 gray (Gy), up to a total dose of 56 Gy to the pelvis. Brachytherapy was given to the vaginal vault either with 2 radium applications (median: 1600 milligram-hours to the applicator surface) or, in the majority of cases, with 3 fractions of high dose rate afterloading applications (iridium-192, 10-Curie source) with 7 Gy each to an isodose 7.5 mm from the applicator surface. RESULTS The 5-year actuarial overall survival, disease specific survival, and local control rates for 72 patients were 52.3%, 58.5%, and 77.9%, respectively; in Stage I patients they were 74.8%, 84.6%, and 94.4%, respectively; in Stage II patients they were 53.3%, 53.3%, and 88.9%, respectively; in Stage III patients they were 15.7%, 17.9%, and 55.5%, respectively; and in Stage IV patients they were 0%, 0%, and 0%, respectively. For LMS, the 5-year actuarial overall survival, disease specific survival, and local control rates were 49.4%, 52.0%, and 76.0%, respectively; for ESS they were 81.8%, 81.8%, and 90.9%, respectively; and for MMT they were 42.3%, 54.9%, and 72.4%, respectively. CONCLUSIONS These data suggest that adjuvant radiotherapy is an effective treatment for uterine sarcoma with regard to disease specific survival in patients with early stage disease and increases local control, even in patients with advanced stage disease.
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Affiliation(s)
- T H Knocke
- Department of Radiotherapy and Radiobiology, General Hospital Vienna, University of Vienna, Austria
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Arrastia CD, Fruchter RG, Clark M, Maiman M, Remy JC, Macasaet M, Gates EJ, Di Maio T, Marzec T. Uterine carcinosarcomas: incidence and trends in management and survival. Gynecol Oncol 1997; 65:158-63. [PMID: 9103406 DOI: 10.1006/gyno.1997.4629] [Citation(s) in RCA: 89] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Our study's aim was to determine the incidence of uterine sarcomas in New York City (NYC) and evaluate trends in frequency, treatment, and survival of carcinosarcomas in two Brooklyn hospitals. Population-based cancer registry data for 1976-1985 were used to calculate the incidence of uterine sarcomas in NYC women. Medical records and histology slides of carcinosarcomas at two central Brooklyn hospitals from 1960 to 1995 were reviewed. The incidence of uterine sarcomas in black and white women in NYC was 33.4 and 17.0 per million (P < 0.01). Among 97 women with carcinosarcomas diagnosed in 1960-1995, 75% were diagnosed preoperatively, 82% had a hysterectomy, and 45% of those in clinical stage I were upstaged. Predictors of mortality included the presence of extrauterine extension, deep myometrial invasion, vascular space invasion, and gross residual disease, with only the first two being independent predictors of survival in a multivariate analysis. Adjunctive therapy shifted from radiation in 1960-1969 to cisplatin-based chemotherapy after 1980. In surgical stage III, survival increased significantly between 1960-1979 and 1980-1995, but improvement could not be ascribed to particular therapies. The incidence of uterine sarcomas in black women was twice that in white women. Surgical staging including omentectomy is recommended in the management of carcinosarcomas. Modern medical care may have improved the short-term prognosis of carcinosarcomas.
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Affiliation(s)
- C D Arrastia
- Department of Obstetrics and Gynecology, State University of New York-Health Science Center at Brooklyn, 11203, USA
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