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.