Title: Outcome of Treatment in Uterine Sarcoma: Fifteen Years Experience at A Regional Cancer Centre
Author: Dr Ujwala Prakash Wakpaijan
DOI: https://dx.doi.org/10.18535/jmscr/v5i3.214
Abstract
Objective: To evaluate the pattern of recurrence and survival of uterine sarcoma patients treated at regional cancer centre.
Background: Uterine sarcomas are a rare but extremely aggressive subtype of uterine malignancies. The prognosis is poor and the role of adjuvant treatment has not yet been established.
Methods: We conducted a retrospective analysis of the medical records of patients diagnosed with uterine sarcomas who were treated in our Institute from 1998 to 2013. The tumour characteristics, stage of disease, treatment modalities, histological types, follow up and survival were studied. Patients with metastatic disease at diagnosis were excluded from the analysis.
Results: A total of 38 patients were selected for the study. Among these, 16 patients (42%) were operated elsewhere and the remaining 22 patients (58%) underwent surgery in our institution. The proportion of patients with Stage I, II and III disease according to the FIGO staging were73.5%, 21% and 5.5% respectively. The histological types included Carcinosarcomas (47.5%), liomyosarcomas (26%), endometrial stromal sarcoma high grade (7%), endometrial stromal sarcoma low grade (13%) and undifferentiated tumours (7%). Among the patients who underwent surgery in our institution, 68 % patients received adjuvant radiotherapy to the pelvis, 14 % received adjuvant radiotherapy and sequential chemotherapy, 14 % received only chemotherapy and one patient received no adjuvant treatment. At last follow-up, 27 patients (76.3%) had died of the disease and 9 (23.7%) are alive & healthy. The median disease free survival was 17 months (range 5 to 39 months). And median overall survival was 39 months range (6 to 60 months). Distant metastasis outside the abdominal cavity occurred in 17 patients, whereas peritoneal and pelvic recurrence was seen in 10 and 3 patients respectively.
Conclusion: Surgery remains the main stay of treatment for uterine sarcoma regardless of histological type of tumour. Most important part of surgery is to resect the tumour with all margins free of tumour. The prognostic factors for improved survival are stage I, II disease. Adequate surgery with good tumour free margins in the pelvis, Adjuvant with radiotherapy by external beam RT to pelvis had prevented the local recurrences but did not improve overall survival. Prospective clinical trials with adjuvant modalities treatment are needed to improve survival.
Keywords: uterine sarcoma, endometrial stromal sarcoma, Carcinosarcomas, survival.
References
1. Toro, J. R. et al. Incidence patterns of soft tissue sarcomas, regardless of primary site, in the surveillance, epidemiology and end results program, 1978-2001: An analysis of 26,758 cases. International journal of cancer119, 2922-2930 (2006).
2. Bocker, W. [WHO classification of breast tumors and tumors of the female genital organs: pathology and genetics]. Verhand-lungen der Deutschen Gesellschaft fur Pathologie86, 116-119 (2002).
3. D'Angelo, E., Spagnoli, L. G. &Prat, J. Comparative clinicopathologic and immunohistochemical analysis of uterine sarcomas diagnosed using the World Health Organization classification system. Human pathology40, 1571-1585 (2009).
4. D'Angelo, E. &Prat, J. Uterine sarcomas: a review. Gynecologic oncology116, 131-139 (2010).
5. Wolfson, A. H. et al. A multivariate analysis of clinicopathologic factors for predicting outcome in uterine sarcomas. Gynecologic oncology52, 56-62 (1994).
6. Hensley, M. L. et al. Adjuvant therapy for high-grade, uterus-limited leiomyosa-rcoma: results of a phase 2 trial (SARC 005). Cancer119, 1555-1561 (2013).
7. Giuntoli, R. L., 2nd et al. Retrospective review of 208 patients with leiomyo-sarcoma of the uterus: prognostic indicators, surgical management, and adjuvant therapy. Gynecologic oncology89, 460-469 (2003).
8. Li, N. et al. Treatment options in stage I endometrial stromal sarcoma: a retrospective analysis of 53 cases. Gynecologiconcology108, 306-311 (2008).