Alessandra Franzetti Pellanda1,2, Berardino De Bari1,3, Elisabeth Deniaud-Alexandre4,5, Marco Krengli6, Paul Van Houtte7, Antonella Richetti8,9, Salvador Villà10, Hadassah Goldberg11, Ewa Szutowicz-Zielińska12, Michel Bolla13, Heidi Rutten14, Marc Van Eijkeren15, Philip Poortmans14,16, Guido Henke17, Yavuz Anacak18, Steve Chan19, Christine Landmann20, Carine Kirkove21, Luciano Scandolaro22, Jacques Bernier23,24, René-Olivier Mirimanoff1, Mahmut Ozsahin1. 1. Centre Hospitalier Universitaire Vaudois (CHUV), 1011 Lausanne, Switzerland. 2. Clinica Luganese Moncucco, 6903 Lugano, Switzerland. 3. Centre Hospitalier Régional Universitaire "Jean Minjoz", INSERM, UMR1098, 25030 Besançon, France. 4. Hôpital Tenon, 75970 Paris, France. 5. Centre Hospitalier Départemental, 85925 Vendee, France. 6. Università degli Studi del Piemonte Orientale e Ospedale Maggiore della Carità, 28100 Novara, Italy. 7. Institut Jules Bordet, 1000 Brussels, Belgium. 8. Ospedale di Circolo, 21100 Varese, Italy. 9. Istituto Oncologico della Svizzera Italiana, EOC, 6500 Bellinzona, Switzerland. 10. Catalan Institute of Oncology, Universitat Autònoma de Barcelona, 08916 Barcelona 08916, Spain. 11. Rambam Medical Center, 31096 Haifa, Israel. 12. Medical University, 80210 Gdansk, Poland. 13. Hôpital Michallon, BP217, 38043, Grenoble cedex 09, France. 14. Radboud University Medical Center, 6525 Nijmegen, The Netherlands. 15. Ghent University Hospital, 9000 Gent, Belgium. 16. Institute Verbeeten, 90120 Tilburg, The Netherlands. 17. Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland. 18. Karadeniz Technical University, 61080 Trabzon, Turkey. 19. Nottingham University Hospital, NHS trust, NG5 1PB Nottingham, United Kingdom. 20. Kantonsspital Basel, 4031 Basel, Switzerland. 21. UCL St. Luc, 1200 Brussels, Belgium. 22. Presidio Ospedaliero Sant'Anna, 22100 Como, Italy. 23. Ospedale San Giovanni, 6500 Bellinzona, Switzerland. 24. Clinique de Genolier, Genolier, 1272 Switzerland.
Abstract
OBJECTIVE: Primary uterine leiomyosarcomas (ULMS) are rare, and the optimal treatment is controversial. We aimed to assess the outcome and prognostic factors in a multicenter population of women treated for primary ULMS. METHODS: We retrospectively collected data of 110 women treated in 19 institutions of the Rare Cancer Network (RCN). Inclusion criteria consisted of a pathology report confirming the diagnosis of ULMS, aged 18-80 years, complete International Federation of Gynecology and Obstetrics (FIGO) stage information, complete information on treatment, and a minimum follow-up of 6 months. Local control (LC) and locoregional control (LRC), overall survival (OS) and disease-free survival (DFS) rates were computed using the Kaplan-Meier method. Univariate analysis was implemented using the log rank test, and multivariate analysis using the Cox model. RESULTS: All patients underwent surgery. Seventy-five patients (68%) received adjuvant radiotherapy (RT), including brachytherapy in 18 (16%). Seventeen patients (15%) received adjuvant chemotherapy. Median follow-up was 58 (range, 6-240) months. Five-year OS and DFS rates were 50% and 34%, and LC and LRC rates were 88% and 72%, respectively. On multivariate analysis, independent favorable prognostic factors were younger age, FIGO stage I, small tumor size, previous uterine disease, and no vascular invasion for OS and DFS. FIGO stage was the only favorable factor influencing LRC. Adjuvant local or systemic treatments did not improve the outcomes. Eight patients treated with RT presented a grade 3 acute toxicity, and only one patient with grade 3 late toxicity. CONCLUSIONS: In this large population of primary ULMS patients, we found good results in terms of LC and LRC. Nevertheless, OS remains poor, mainly due to the occurrence of distant metastases. An early diagnosis seemed to improve the prognosis of the patients. Adjuvant local or systemic treatments, or more aggressive surgical procedures such as the Wertheim procedure, did not seem to impact the outcome.
OBJECTIVE: Primary uterine leiomyosarcomas (ULMS) are rare, and the optimal treatment is controversial. We aimed to assess the outcome and prognostic factors in a multicenter population of women treated for primary ULMS. METHODS: We retrospectively collected data of 110 women treated in 19 institutions of the Rare Cancer Network (RCN). Inclusion criteria consisted of a pathology report confirming the diagnosis of ULMS, aged 18-80 years, complete International Federation of Gynecology and Obstetrics (FIGO) stage information, complete information on treatment, and a minimum follow-up of 6 months. Local control (LC) and locoregional control (LRC), overall survival (OS) and disease-free survival (DFS) rates were computed using the Kaplan-Meier method. Univariate analysis was implemented using the log rank test, and multivariate analysis using the Cox model. RESULTS: All patients underwent surgery. Seventy-five patients (68%) received adjuvant radiotherapy (RT), including brachytherapy in 18 (16%). Seventeen patients (15%) received adjuvant chemotherapy. Median follow-up was 58 (range, 6-240) months. Five-year OS and DFS rates were 50% and 34%, and LC and LRC rates were 88% and 72%, respectively. On multivariate analysis, independent favorable prognostic factors were younger age, FIGO stage I, small tumor size, previous uterine disease, and no vascular invasion for OS and DFS. FIGO stage was the only favorable factor influencing LRC. Adjuvant local or systemic treatments did not improve the outcomes. Eight patients treated with RT presented a grade 3 acute toxicity, and only one patient with grade 3 late toxicity. CONCLUSIONS: In this large population of primary ULMS patients, we found good results in terms of LC and LRC. Nevertheless, OS remains poor, mainly due to the occurrence of distant metastases. An early diagnosis seemed to improve the prognosis of the patients. Adjuvant local or systemic treatments, or more aggressive surgical procedures such as the Wertheim procedure, did not seem to impact the outcome.
Entities:
Keywords:
Uterine leiomyosarcoma; local control; overall survival; prognostic factors; radiotherapy
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