Does radiotherapy or lymphadenectomy improve survival in endometrial stromal sarcoma?

INTRODUCTION: Endometrial stromal sarcoma (ESS) is a rare uterine malignancy characterized by cells resembling proliferative-phase endometrial stroma. Standard treatment is total hysterectomy and bilateral salpingo-oophorectomy (TAH-BSO). The roles of radiation therapy (RT) and lymphadenectomy (LAD) remain unclear. Using a large population database, we retrospectively evaluated the addition of RT and LAD to surgery for survival impact.
METHODS: We identified 1010 women with ESS between 1983 and 2002 from the National Cancer Institute's Surveillance, Epidemiology, and End Results Program. Kaplan-Meier method was used to estimate overall survival (OS) and cause-specific survival (CSS). Outcomes for patients treated by TAH-BSO alone and surgery plus RT were compared using Cox proportional hazards regression model. A multivariate analysis controlling for age, International Federation of Gynecology and Obstetrics (FIGO) stage, LAD, race, year of diagnosis, and tumor grade was performed. Univariate analyses were performed for individual FIGO stages, low- and high-grade tumors, and surgery with and without LAD. A literature review was performed to compile studies showing LAD data for ESS.
RESULTS: The median follow-up was 54 months (range, 1-248 months). The 5-year OS and CSS for patients undergoing surgery plus RT were 72.2% and 80.1% and 83.2% and 90.7% for surgery alone, respectively. Worse prognoses were associated with increasing FIGO stage, tumor grade, and age. Neither did adjuvant RT correlate with improved survival within any FIGO stage nor did it alter survival for low- or high-grade tumor groups. Adding lymphadenectomy to TAH-BSO did not change survival.