Rosanna Mancari1, Mauro Signorelli2, Angiolo Gadducci3, Silvestro Carinelli4, Elena De Ponti5, Silvia Sesana6, Silvia Corso7, Valentina Chiappa8, Nicoletta Colombo9, Andrea Alberto Lissoni10. 1. Division of Gynecologic Oncology, European Institute of Oncology, Viale Ripamonti 435, 20085 Milan, Italy. Electronic address: rosanna.mancari@ieo.it. 2. Department of Obstetrics and Gynecology, San Gerardo Hospital, Monza, Italy; University of Milan-Bicocca, Milan, Italy. Electronic address: maurosignorelli78@gmail.com. 3. Department of Procreative Medicine, Division of Gynecology and Obstetrics, University of Pisa, Italy. Electronic address: a.gadducci@obgyn.med.unipi.it. 4. Division of Pathology and Laboratory Medicine, European Institute of Oncology, Milan, Italy. Electronic address: silvestro.carinelli@ieo.it. 5. Medical Physics Department, San Gerardo Hospital, Monza, Italy. Electronic address: e.deponti@hsgerardo.org. 6. Clinical Data Managing, European Institute of Oncology, Milan, Italy. Electronic address: silviasesana16@tiscali.it. 7. Department of Obstetrics and Gynecology, San Gerardo Hospital, Monza, Italy; University of Milan-Bicocca, Milan, Italy. Electronic address: silviacorso80@gmail.com. 8. Department of Obstetrics and Gynecology, San Gerardo Hospital, Monza, Italy; University of Milan-Bicocca, Milan, Italy. Electronic address: valentina.chiappa@gmail.com. 9. Division of Gynecologic Oncology, European Institute of Oncology, Viale Ripamonti 435, 20085 Milan, Italy. Electronic address: nicoletta.colombo@ieo.it. 10. Department of Obstetrics and Gynecology, San Gerardo Hospital, Monza, Italy; University of Milan-Bicocca, Milan, Italy. Electronic address: andreaalberto.lissoni@unimib.it.
Abstract
OBJECTIVE: 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.
OBJECTIVE: 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.
Authors: Bruna Cristine de Almeida; Laura Gonzalez Dos Anjos; Miyuki Uno; Isabela Werneck da Cunha; Fernando Augusto Soares; Glauco Baiocchi; Edmund Chada Baracat; Katia Candido Carvalho Journal: Cells Date: 2019-11-17 Impact factor: 6.600