TY - JOUR
T1 - Adjuvant chemotherapy in stage I-II uterine leiomyosarcoma
T2 - A multicentric retrospective study of 140 patients
AU - Mancari, Rosanna
AU - Signorelli, Mauro
AU - Gadducci, Angiolo
AU - Carinelli, Silvestro
AU - De Ponti, Elena
AU - Sesana, Silvia
AU - Corso, Silvia
AU - Chiappa, Valentina
AU - Colombo, Nicoletta
AU - Lissoni, Andrea Alberto
PY - 2014
Y1 - 2014
N2 - Objective About 50-60% of patients with stage I-II uterine leiomyosarcoma (ULMS), primarily treated with surgery, relapse and die from progressive disease. In this retrospective study we describe the impact of adjuvant chemotherapy in this subset of patients. Methods 140 women treated from 1976 to 2011 were included in the study. Univariate and multivariate analysis were used to test the association of clinical features and adjuvant treatments with overall survival (OS) and disease-free survival (DFS). Results 62 women did not receive any further treatment after hysterectomy, 14 had radiotherapy (RT), 52 chemotherapy and 12 chemo-radiotherapy. Chemotherapy based on doxorubicin and ifosfamide combination was used in 54 cases. After a median follow-up of 63 months, 87 women (62%) have relapsed, and 62 (44%) have died. The vast majority of patients who relapsed had distant recurrences (72%). The 5 year median DFS and OS were 43% and 64% respectively. After 5 years of follow up 68.7% of women treated with chemotherapy (± RT) vs 65.6% of patients only observed were alive (p = 0.521). In the univariate analysis no factors had a statistical impact on DFS, while number of mitosis (> 20 × 10HPF), age (> 60 years) and adjuvant radiotherapy were found as negative prognostic factors for OS. In the multivariate analysis only mitosis and age remained significant for OS. Conclusion Adjuvant chemotherapy was not associated with a significant survival benefit and should not be considered as standard of care for patients with stage I-II ULMS until randomized clinical studies will give further information.
AB - Objective About 50-60% of patients with stage I-II uterine leiomyosarcoma (ULMS), primarily treated with surgery, relapse and die from progressive disease. In this retrospective study we describe the impact of adjuvant chemotherapy in this subset of patients. Methods 140 women treated from 1976 to 2011 were included in the study. Univariate and multivariate analysis were used to test the association of clinical features and adjuvant treatments with overall survival (OS) and disease-free survival (DFS). Results 62 women did not receive any further treatment after hysterectomy, 14 had radiotherapy (RT), 52 chemotherapy and 12 chemo-radiotherapy. Chemotherapy based on doxorubicin and ifosfamide combination was used in 54 cases. After a median follow-up of 63 months, 87 women (62%) have relapsed, and 62 (44%) have died. The vast majority of patients who relapsed had distant recurrences (72%). The 5 year median DFS and OS were 43% and 64% respectively. After 5 years of follow up 68.7% of women treated with chemotherapy (± RT) vs 65.6% of patients only observed were alive (p = 0.521). In the univariate analysis no factors had a statistical impact on DFS, while number of mitosis (> 20 × 10HPF), age (> 60 years) and adjuvant radiotherapy were found as negative prognostic factors for OS. In the multivariate analysis only mitosis and age remained significant for OS. Conclusion Adjuvant chemotherapy was not associated with a significant survival benefit and should not be considered as standard of care for patients with stage I-II ULMS until randomized clinical studies will give further information.
KW - Adjuvant therapy
KW - Chemotherapy
KW - Prognostic factors
KW - Uterine leiomyosarcoma
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U2 - 10.1016/j.ygyno.2014.03.001
DO - 10.1016/j.ygyno.2014.03.001
M3 - Article
C2 - 24631454
AN - SCOPUS:84901659806
VL - 133
SP - 531
EP - 536
JO - Gynecologic Oncology
JF - Gynecologic Oncology
SN - 0090-8258
IS - 3
ER -