Adjuvant chemotherapy in stage I-II uterine leiomyosarcoma: A multicentric retrospective study of 140 patients

Rosanna Mancari, Mauro Signorelli, Angiolo Gadducci, Silvestro Carinelli, Elena De Ponti, Silvia Sesana, Silvia Corso, Valentina Chiappa, Nicoletta Colombo, Andrea Alberto Lissoni

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish
Pages (from-to)531-536
Number of pages6
JournalGynecologic Oncology
Volume133
Issue number3
DOIs
Publication statusPublished - 2014

Keywords

  • Adjuvant therapy
  • Chemotherapy
  • Prognostic factors
  • Uterine leiomyosarcoma

ASJC Scopus subject areas

  • Obstetrics and Gynaecology
  • Oncology

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