On the Apparent Failure of Adjuvant Pelvic Radiotherapy to Improve Survival for Women With Uterine Sarcomas Confined to the Uterus

Abstract

Despite numerous studies documenting reduction of pelvic relapses after adjuvant pelvic radiotherapy stage I and II uterine sarcomas, improved survival remains unproven. This retrospective report analyzes patterns of failure, survival, and toxicity in 42 women with stage I and 7 patients with stage II uterine sarcomas treated from 1972 through 1998 to identify patients likely to benefit from pelvic or abdominal radiotherapy and chemotherapy. Four of these patients also received adjuvant chemotherapy. There were 20 leiomyosarcomas, 18 homologous mixed mullerian tumors, and 11 heterologous mixed mullerian tumors. Disease-free survivals for mixed mullerian tumors were 65% at 5 years and 61% at 15 years. Disease-free survivals for leiomyosarcomas were 40% at 5 years and 40% at 15 years. There were 14 distant only, 5 distant and abdominal, 1 abdominal, 1 distant and pelvic, and 2 unknown initial sites of failure. Acute toxicity was acceptable as measured by a median 1-kg weight loss from radiotherapy and a 2% rate of failure to complete therapy. Chronic toxicity consisted of 3 small bowel obstructions and 1 sigmoid colon obstruction. In conclusion, the efficacy of adjuvant pelvic radiation is demonstrated by the absence of any isolated pelvic failures. Although the frequent occurrence of peritoneal failures suggests a role for prophylactic abdominal radiation for mixed mullerian tumors, more effective systemic therapy is necessary to substantially increase the chance of cure for women with early-stage uterine sarcomas.

A gynecologic oncology group randomized phase III trial of whole abdominal irradiation (WAI) vs. cisplatin-ifosfamide and mesna (CIM) as post-surgical therapy in stage I–IV carcinosarcoma (CS) of the uterus☆

“…17,18,19,20,21,22,23,24,25,26,27 Those that have involved postoperative pelvic EBRT have shown a consistent decrease in pelvic failures but no significant impact on overall patient survival. 17,19,20,21,22,23,24,27 However, two retrospective studies did claim an OS benefit with the addition of adjuvant pelvic irradiation for patients with surgical stage I and II disease. 25,26 When comparing the patterns of failure between WAI and CIM in GOG-150 for stages I/II/ III/IV, only vaginal recurrences appeared to be increased in the chemotherapy cohort versus the radiotherapy cohort.…”

Uterine Neoplasms

“…[103][104][105][106][107][108] In some series, this local control improvement correlates with an improvement in survival, although other data show that lymphadenectomy confers greater benefit. [107][108][109][110] A phase III randomized GOG trial (150) involving patients with carcinosarcoma of the uterus assessed whole abdominal RT versus cisplatin and ifosfamide, but no difference in survival was seen between the groups.…”

Molecular Pathology and Novel Clinical Therapy for Uterine Leiomyosarcoma

“…In light of significant effects achieved using antibody therapies directed against tumour-specific antigens, molecular targeting is regarded as a promising strategy for the treatment of malignant tumours (14). Although gynaecological cancer, for instance breast cancer and endometrial carcinomas, are strongly promoted by female hormones, the rates of oestrogen and progesterone receptor expression is reported to be significantly less in uterine LMS compared to the normal myometrium, and were found not to correlate with the promotion of initial disease development or with overall survival (15).…”