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

AbstractOBJECTIVE:
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 63months, 87 women (62%) have relapsed, and 62 (44%) have died. The vast majority of patients who relapsed had distant recurrences (72%). The 5year median DFS and OS were 43% and 64% respectively. After 5years 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 (>60years) 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.
AuthorsRosanna Mancari, Mauro Signorelli, Angiolo Gadducci, Silvestro Carinelli, Elena De Ponti, Silvia Sesana, Silvia Corso, Valentina Chiappa, Nicoletta Colombo, Andrea Alberto Lissoni
JournalGynecologic oncology (Gynecol Oncol) Vol. 133 Issue 3 Pg. 531-6 (Jun 2014) ISSN: 1095-6859 [Electronic] United States
PMID24631454 (Publication Type: Journal Article, Multicenter Study, Observational Study)
CopyrightCopyright © 2014 Elsevier Inc. All rights reserved.
Chemical References
  • Doxorubicin
  • Ifosfamide
Topics
  • Adult
  • Aged
  • Antineoplastic Combined Chemotherapy Protocols (therapeutic use)
  • Chemoradiotherapy, Adjuvant (methods)
  • Chemotherapy, Adjuvant (methods)
  • Disease-Free Survival
  • Doxorubicin (administration & dosage)
  • Female
  • Humans
  • Hysterectomy
  • Ifosfamide (administration & dosage)
  • Leiomyosarcoma (drug therapy, mortality, pathology)
  • Middle Aged
  • Multivariate Analysis
  • Neoplasm Recurrence, Local
  • Neoplasm Staging
  • Prognosis
  • Radiotherapy, Adjuvant (methods)
  • Retrospective Studies
  • Treatment Outcome
  • Uterine Neoplasms (drug therapy, mortality, pathology)
  • Young Adult

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