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Original Research

Open Access

Treatment patterns for leiomyosarcomas, endometrial stromal sarcomas and adenosarcomas: a national cancer database study

  • Jessica Kunzman1
  • Ryan Hutten2,3
  • Kristen Kelley1
  • Kate Harris3,4
  • David K. Gaffney2,3
  • Cristina DeCesaris2,3
  • Gita Suneja2,3
  • Lindsay M. Burt2,3,*,

1University of Utah School of Medicine, Salt Lake City, UT 84112, USA

2Department of Radiation Oncology, University of Utah School of Medicine, Salt Lake City, UT 84112, USA

3Huntsman Cancer Institute, Salt Lake City, UT 84112, USA

4Department of Gynecologic Oncology, University of Utah School of Medicine, Salt Lake City, UT 84112, USA

DOI: 10.22514/ejgo.2023.019 Vol.44,Issue 2,April 2023 pp.25-31

Submitted: 01 November 2022 Accepted: 16 March 2023

Published: 15 April 2023

*Corresponding Author(s): Lindsay M. Burt E-mail: Lindsay.Burt@hci.utah.edu

Abstract

Uterine sarcomas are a rare, heterogenous, group of cancers with limited data on optimal adjuvant treatment. We examined patterns of care for leiomyosarcomas (LMS), endometrial stromal sarcomas (ESS), adenosarcomas (AS), and mixed uterine sarcomas and assessed the utilization of adjuvant therapy for each histology. The National Cancer Database (NCDB) was queried for patients with non-metastatic uterine sarcoma diagnosed between 2004 and 2018 treated with surgery. Uterine carcinosarcomas were excluded. Adjuvant patterns of care and temporal treatment trends are evaluated, stratified by histology. Multivariable logistic regression model was constructed to identify predictors of receipt of radiation adjuvant therapy. Among 12,806 patients, 88% received a total hysterectomy and bilateral salpingo-oophorectomy (TH+BSO) and 42% received lymph node sampling (LNS). Surgery alone was the most common treatment modality for all histology groups (59.0%). Surgery with chemotherapy was the second most common form of treatment for LMS (33.1%) and mixed type tumors (29.6%). Surgery with radiation was the second most common treatment for high-grade ESS (10.8%) and AS (11.8%). External beam radiation therapy (EBRT) was the most common type of adjuvant radiation therapy utilized. Adjuvant radiation therapy (RT) has declined in LMS, from 27% in 2004 to 3% in 2018. Adjuvant chemotherapy for all histology groups has increased in use from 10% in 2004 to 28% in 2018. For uterine sarcomas, TH+BSO without LNS was the main surgical modality. Adjuvant therapy for uterine sarcomas is not commonly used, however high risk features including stage II/III, high grade, and more extensive lymph node sampling appear to increase the likelihood of adjuvant RT. The utilization of adjuvant chemotherapy in uterine sarcomas has increased over time, while RT has been decreasing.


Keywords

Uterine sarcoma; Treatment; Radiation therapy; Chemotherapy; Surgery; Leiomyosarcoma; Endometrial stromal sarcoma; Adenosarcoma


Cite and Share

Jessica Kunzman,Ryan Hutten,Kristen Kelley,Kate Harris,David K. Gaffney,Cristina DeCesaris,Gita Suneja,Lindsay M. Burt. Treatment patterns for leiomyosarcomas, endometrial stromal sarcomas and adenosarcomas: a national cancer database study. European Journal of Gynaecological Oncology. 2023. 44(2);25-31.

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