Is adjuvant treatment in early-stage uterine sarcomas beneficial?

Objective: To compare overall survival (OS) and disease-free period (DFP) in patients with uterine sarcomas (US) in early stages with and without adjuvant treatment. Materials and Methods: One hundred sixteen clinical files with a diagnosis of US were reviewed. These were distributed into two groups: those who received adjuvant treatment with chemotherapy (CT) and/or radiotherapy (RT), and those who did not. Chi-square test was utilized for qualitative and the Mann–Whitney U test for quantitative variables. OS and the DFP were calculated with the Kaplan–Meier method and compared with the log-rank test. Results: Forty-seven patients were identified with clinical Stages I and II, of whom 25 patients (53.1%) received adjuvant treatment and 22 (46.8%) did not. Of the first group, 18 (72%) were treated with RT and 12 (48%) received CT. Five-year OS in patients who received adjuvant treatment was 68.05% (CI: 41.27–84.58) in comparison with those who did not, which was 78.41% (CI: 51.99–91.36, p = 0.41). Five-year DFP in the group that received adjuvant treatment was 46.88% (95% CI, 25.21–65.94), and in the group that did not it was 52.89% (95% CI, 30.00–71.39, p = 0.56). Conclusion: In early stage US, the benefit in OS and DFP using adjuvant management is limited, therefore, it has to be offered cautiously or not offered to this particular group of patients. Larger number of patients needs to be evaluated and collaborative phase III trial conducted in order to establish the role of adjuvant CT or RT for these neoplasms.

Sarcomas; Uterine neoplasm; Radiotherapy; Chemotherapy; Adjuvant; Cytoreduction.

[1] Cantú de León D., González H., Pérez-Montiel D., Coronel J., Pérez- Plasencia C., Villavicencio-Valencia V., et al.: “Uterine sarcomas: review of 26 years at The Instituto Nacional de Cancerologia of Mexico”. In.t J. Surg., 2013, 11, 518.

[2] Cárdenas Serrano O.E.: “Diagnóstico de sarcoma uterino, revisión de

11 casos”. Ginecol. Obstet. Mex., 2015, 83, 515. Available at: http://www.medigraphic.com/pdfs/ginobsmex/gom2015/gom159b.pdf

[3] El-Khalfaoui K., du Bois A., Heitz F., Kurzeder C., Sehouli, J., Harter P.: “Current and future options in the management and treatment of uterine sarcoma”. Ther. Adv. Med. Oncol., 2014, 6, 21.

[4] Tropé C.G, Abeler V.A., Kristensen G.B.: “Diagnosis and treatment of sarcoma of the uterus. A review”. Acta Oncol., 2012, 51, 694. Available at: http://www.tandfonline.com/doi/pdf/10.3109/

0284186X.2012.689111

[5] Mangionib C., Malmströmc H., Scarfoned G.: “Phase III randomised study to evaluate the role of adjuvant pelvic radiotherapy in the treatment of uterine sarcomas stages I and II: A European Organisation for Research and Treatment of Cancer Gynaecological Cancer Group Study. Eur. J. Cancer, 2008, 44, 6, Pages 808–818Available at: http://ac.els-cdn.com/S0959804908000580/1-s2.0-S0959804908000580-main.pdf?_tid=70e14b6c-fc12-11e5-a25a-00000aacb35f&acdnat=1459959363_15fce5ebfbeb987872bc6f93ca22d4e2

[6] Greer B.E.: “NCCN Clinical Practice Guidelines in Oncology; Uterine Neoplasms”. Fred Hutchinson Cancer Research Center, Seattle, WA, USA: Cancer Care Alliance. Version I.2014. Available at: https://www.tri-kobe.org/nccn/guideline/gynecological/english/uterine.pdf

[7] Reichardt P.: “The treatment of uterine sarcomas”. Department of Interdisciplinary Oncology, Sarcoma Center Berlin-Brandenburg, HELIOS Klinikum Berlin-Buch, Berlin, Germany. Ann. Oncol., 2012, 23,

151. Available at: http://annonc.oxfordjournals.org/content/23/suppl_10/x151.full

[8] Martee L., Hensley M.D.: “Adjuvant therapy for high-grade, uteruslimited leiomyosarcoma”. Cancer, 2013, 119, 1555. Available at: http://onlinelibrary.wiley.com/doi/10.1002/cncr.27942/pdf

[9] Sorbe B.: “Radiotherapy and/or chemotherapy as adjuvant treatment of uterine sarcomas”. Gynecol. Oncol., 1985, 20, 281. Available at: h t t p : / / a c . e l s - c d n . c o m / 0 0 9 0 8 2 5 8 8 5 9 0 2 0 9 4 / 1 - s 2 . 0 -0090825885902094-main.pdf?_tid=764aca48-fc16-11e5-81a0-00000aab0f6c&acdnat=1459961090_2dffb85b830b4b90e57a0aa1e2bbafe0

[10] Ramondetta L.M., Bodurka D.C., Deavers M.T., Jhingran A.: “Uterine sarcomas”. Available at: http://eknygos.lsmuni.lt/springer/179/ 125-147.pdf

[11] D’Angelo E., Jaime Prat J.: “Uterine sarcomas: a review”. Gynecol. Oncol., 2010, 116, 131.

[12] Mancari R., Signorelli M.: Adjuvant chemotherapy in stage I-II uterine leiomyosarcoma: a multicentric retrospective study of 140 patients. Gynecol. Oncol., 2014, 133, 531.