Archives of Gynecology and Obstetrics

, Volume 288, Issue 4, pp 873–882

Uterine sarcoma-current management and experience from a regional cancer centre in North India

  • Ahitagni Biswas
  • Firuza Patel
  • Pankaj Kumar
  • Radhika Srinivasan
  • Anjan Bera
  • Suresh C. Sharma
  • Arvind Rajwanshi
Gynecologic Oncology
  • 230 Downloads

Abstract

Purpose

We intended to assess the clinicopathological features and treatment outcome in patients of uterine sarcoma.

Method

A retrospective review of medical records of patients of uterine sarcoma (2002–2007) was conducted. Overall survival (OS) was analyzed by Kaplan–Meier method.

Results

Forty-two patients met the study criterion [15 carcinosarcoma, 12 endometrial stromal sarcoma, 11 leiomyosarcoma, 3 undifferentiated endometrial sarcoma (UES), and 1 mixed sarcoma]. Median age and performance status were 52 years and ECOG 0, respectively. All patients underwent primary surgery out of which 66.7 % was total abdominal hysterectomy and bilateral salpingo-oophorectomy. FIGO (2009) stage was I, II, III, IV and unknown in 66.7, 7.1, 14.3, 9.5, and 2.4 % of the patients. Eight patients were kept on follow-up only. Adjuvant radiation, chemoradiation, and chemotherapy were offered in 8, 9, and 3 patients, respectively. Pelvic radiation: 46 Gray/23 fractions/4.5 weeks and vincristine, adriamycin, cyclophosphamide (VAC) regimen were most commonly used. Overall clinical complete response (CR), stable disease (SD), and progressive disease (PD) were, respectively, 59.5, 2.4, and 26.2 % (response not evaluable in 12 %). In the evaluable patients (N = 33), median OS was noted to be 7.67 months (mean 30.19 months). 1- and 2-year actuarial survival were 45.45 and 36.36 %. Stratified by histology, median survival in patients with carcinosarcoma, endometrial stromal sarcoma, leiomyosarcoma, and UES were, respectively, 6.57, 18.7, 6.8, and 9.38 months. On univariate analysis, response to therapy (p = 0.0003), disease stage (p = 0.00001), tumor size (p = 0.02), and performance status (p = 0.03) were significant predictors of OS. Disease stage (p = 0.005) and response to therapy (p = 0.01) retained significance on multivariate analysis.

Conclusions

Median OS of only 6.57, 6.8, and 9.38 months, respectively, in patients with carcinosarcoma, leiomyosarcoma, and UES in our series reflect the aggressive clinical course and poor prognosis of these rare neoplasms, which mandate intensive multimodality therapy. Even in low-grade endometrial stromal sarcoma, median survival of 18.7 months in our series is far from satisfying. However, small series, poor treatment compliance and socio-economic constraints in the Indian scenario are limiting factors in the result analysis.

Keywords

Sarcoma Uterus 

References

  1. 1.
    Salazar OM, Bonfiglio TA, Patten SF, Keller BE, Feldstein M, Dunne ME et al (1978) Uterine sarcomas: natural history, treatment and prognosis. Cancer 42:1152–1160PubMedCrossRefGoogle Scholar
  2. 2.
    Nordal RR, Thoresen SO (1997) Uterine sarcomas in Norway 1956–1992: incidence, survival and mortality. Eur J Cancer 33:907–911PubMedCrossRefGoogle Scholar
  3. 3.
    Harlow BL, Weiss NS, Lofton S (1986) The epidemiology of sarcomas of the uterus. J Natl Cancer Inst 76:399–402PubMedGoogle Scholar
  4. 4.
    Jonson AL, Bliss RL, Truskinovsky A, Judson P, Argenta P, Carson L et al (2006) Clinical features and outcomes of uterine and ovarian carcinosarcoma. Gynecol Oncol 100:561–564PubMedCrossRefGoogle Scholar
  5. 5.
    Berchuck A, Rubin SC, Hoskins WJ, Saigo PE, Pierce VK, Lewis JL Jr (1988) Treatment of uterine leiomyosarcoma. Obstet Gynecol 71:845–850PubMedGoogle Scholar
  6. 6.
    Berchuck A, Rubin SC, Hoskins WJ, Saigo PE, Pierce VK, Lewis JL Jr (1990) Treatment of endometrial stromal tumors. Gynecol Oncol 36:60–65PubMedCrossRefGoogle Scholar
  7. 7.
    Lin JF, Slomovitz BM (2008) Uterine sarcoma 2008. Curr Oncol Rep 10:512–518PubMedCrossRefGoogle Scholar
  8. 8.
    Kempson R, Bari W (1970) Uterine sarcomas: classification, diagnosis and prognosis. Hum Pathol 1:331–349PubMedCrossRefGoogle Scholar
  9. 9.
    Zagouri F, Dimopoulos AM, Fotiou S, Kouloulias V, Papadimitriou CA (2009) Treatment of early uterine sarcomas: disentangling adjuvant modalities. World J Surg Oncol 7:38PubMedCrossRefGoogle Scholar
  10. 10.
    Zagouri F, Linardou H, Dimopoulos AM, Papadimitriou CA (2009) Management of advanced stage uterine sarcomas: a bone of contention. Eur J Gynaecol Oncol 30:483–492PubMedGoogle Scholar
  11. 11.
    Bansal N, Herzog T, Burke W, Cohen CJ, Wright JD (2008) The utility of preoperative endometrial sampling for the detection of uterine sarcomas. Gynecol Oncol 110:43–48PubMedCrossRefGoogle Scholar
  12. 12.
    Kahanpaa KV, Wahlstrom T, Grohn P, Heinonen E, Nieminen U, Widholm O (1986) Sarcomas of the uterus: a clinicopathologic study of 119 patients. Obstet Gynecol 67:417–424PubMedGoogle Scholar
  13. 13.
    Sherman ME, Devesa SS (2003) Analysis of racial differences in incidence, survival and mortality for malignant tumors of the uterine corpus. Cancer 98:176–186PubMedCrossRefGoogle Scholar
  14. 14.
    Sartori E, Bazzurini L, Gadducci A, Landoni F, Lissoni A, Maggino T et al (1997) Carcinosarcoma of the uterus: a clinicopathological multicenter CTF study. Gynecol Oncol 67:70–75PubMedCrossRefGoogle Scholar
  15. 15.
    Platz CE, Benda JA (1995) Female genital tract cancer. Cancer 75(1 Suppl):270–294PubMedCrossRefGoogle Scholar
  16. 16.
    Diesing D, Cordes T, Finas D, Löning M, Mayer K, Diedrich K et al (2006) Endometrial stromal sarcomas—a retrospective analysis of 11 patients. Anticancer Res 26:655–661PubMedGoogle Scholar
  17. 17.
    Gadducci A, Sartori E, Landoni F, Zola P, Maggino T, Urgesi A et al (1996) Endometrial stromal sarcoma: analysis of treatment failures and survival. Gynecol Oncol 63:247–253PubMedCrossRefGoogle Scholar
  18. 18.
    Oláh KS, Gee H, Blunt S, Dunn JA, Kelly K, Chan KK (1991) Retrospective analysis of 318 cases of uterine sarcoma. Eur J Cancer 27:1095–1099PubMedCrossRefGoogle Scholar
  19. 19.
    Gadducci A, Cosio S, Romanini A, Genazzani AR (2008) The management of patients with uterine sarcoma: a debated clinical challenge. Crit Rev Oncol Hematol 65:129–142PubMedCrossRefGoogle Scholar
  20. 20.
    Temkin SM, Hellmann M, Lee YC, Abulafia O (2007) Early-stage carcinosarcoma of the uterus: the significance of lymph node count. Int J Gynecol Cancer 17:215–219PubMedCrossRefGoogle Scholar
  21. 21.
    Nemani D, Mitra N, Guo M, Lin L (2008) Assessing the effects of lymphadenectomy and radiation therapy in patients with uterine carcinosarcoma: a SEER analysis. Gynecol Oncol 111:82–88PubMedCrossRefGoogle Scholar
  22. 22.
    Pink D, Lindner T, Mrozek A, Kretzschmar A, Thuss-Patience PC, Dörken B et al (2006) Harm or benefit of hormonal treatment in metastatic low-grade endometrial stromal sarcoma: single center experience with 10 cases and review of the literature. Gynecol Oncol 101:464–469PubMedCrossRefGoogle Scholar
  23. 23.
    Riopel J, Plante M, Renaud MC, Roy M, Têtu B (2005) Lymph node metastases in low-grade endometrial stromal sarcoma. Gynecol Oncol 96:402–406PubMedCrossRefGoogle Scholar
  24. 24.
    Reich O, Winter R, Regauer S (2005) Should lymphadenectomy be performed in patients with endometrial stromal sarcoma? Gynecol Oncol 97:982–983PubMedCrossRefGoogle Scholar
  25. 25.
    Ferrer F, Sabater S, Farrus B, Guedea F, Rovirosa A, Anglada L et al (1999) Impact of radiotherapy on local control and survival in uterine sarcomas: a retrospective study from the Grup Oncologic Catala-Occita. Int J Radiat Oncol Biol Phys 44:47–52PubMedCrossRefGoogle Scholar
  26. 26.
    Hornback NB, Omura G, Major FJ (1986) Observations on the use of adjuvant radiation therapy in patients with stage I and II uterine sarcoma. Int J Radiat Oncol Biol Phys 12:2127–2130PubMedCrossRefGoogle Scholar
  27. 27.
    Gerszten K, Faul C, Kounelis S, Huang Q, Kelley J, Jones MW (1998) The impact of adjuvant radiotherapy on carcinosarcoma of the uterus. Gynecol Oncol 68:8–13PubMedCrossRefGoogle Scholar
  28. 28.
    Clayton Smith D, Kenneth Macdonald O, Gaffney DK (2008) The impact of adjuvant radiation therapy on survival in women with uterine carcinosarcoma. Radiother Oncol 88:227–232PubMedCrossRefGoogle Scholar
  29. 29.
    Gadducci A, Landoni F, Sartori E (1996) Uterine leiomyosarcoma: analysis of treatment failures and survival. Gynecol Oncol 62:25–32PubMedCrossRefGoogle Scholar
  30. 30.
    Weitmann H, Knocke TH, Kucera H, Potter R (2001) Radiation therapy in the treatment of endometrial stromal sarcoma. Int J Radiat Oncol Biol Phys 49:739–748PubMedCrossRefGoogle Scholar
  31. 31.
    Leath C, Huh W, Hyde J, Cohn DE, Resnick KE, Taylor NP et al (2007) A multi-institutional review of outcomes of endometrial stromal sarcoma. Gynecol Oncol 105:630–634PubMedCrossRefGoogle Scholar
  32. 32.
    Reed NS, Mangioni C, Malmstrom H, Scarfone G, Poveda A, Pecorelli S et al (2008) Phase III randomized trial to evaluate the role of adjuvant pelvic radiotherapy in the treatment of uterine sarcomas stage I and II: an European Organisation for Research and Treatment of cancer Gynaecological Cancer Group Study (protocol 55874). Eur J Cancer 44:808–818PubMedCrossRefGoogle Scholar
  33. 33.
    Omura GA, Blessing JA, Major F (1985) A randomized clinical trial of adjuvant adriamycin in uterine sarcoma: a Gynecologic Oncology Group Study. J Clin Oncol 3:1240–1245PubMedGoogle Scholar
  34. 34.
    Resnik E, Chambers S, Carcangiu M (1995) A phase II study of etoposide, cisplatin and doxorubicin chemotherapy in mixed mullerian tumors (MMT) of the uterus. Gynecol Oncol 56:370–375PubMedCrossRefGoogle Scholar
  35. 35.
    Wolfson AH, Brady MF, Rocereto T, Mannel RS, Lee YC, Futoran RJ et al (2007) 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. Gynecol Oncol 107:177–185PubMedCrossRefGoogle Scholar
  36. 36.
    Homesley HD, Filiaci V, Markman M, Bitterman P, Eaton L, Kilgore LC et al (2007) Phase III trial of ifosfamide with or without paclitaxel in advanced uterine carcinosarcoma: a Gynecologic Oncology Group Study. J Clin Oncol 25:526–531PubMedCrossRefGoogle Scholar
  37. 37.
    Fleming G (2008) Gemcitabine/docetaxel—welcome to a new standard. Gynecol Oncol 109:313–315PubMedCrossRefGoogle Scholar
  38. 38.
    Hensley ML, Blessing JA, Degeest K, Abulafia O, Rose PG, Homesley HD (2008) Fixed-dose rate gemcitabine plus docetaxel as second-line therapy for metastatic uterine leiomyosarcoma: a Gynecologic Oncology Group phase II study. Gynecol Oncol 109:323–328PubMedCrossRefGoogle Scholar
  39. 39.
    Hensley ML, Blessing JA, Mannel R, Rose PG (2008) Fixed-dose rate gemcitabine plus docetaxel as first-line therapy for metastatic uterine leiomyosarcoma: a Gynecologic Oncology Group phase II trial. Gynecol Oncology 109:329–334CrossRefGoogle Scholar
  40. 40.
    Sharma DN, Rath GK, Kumar S, Kumar L, Bhatia N, Gandhi AK, Hariprasad R (2011) Clinical outcome of patients with uterine sarcoma. J Cancer Res Ther 7:270–274PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Ahitagni Biswas
    • 1
    • 3
  • Firuza Patel
    • 1
  • Pankaj Kumar
    • 1
  • Radhika Srinivasan
    • 2
  • Anjan Bera
    • 1
  • Suresh C. Sharma
    • 1
  • Arvind Rajwanshi
    • 2
  1. 1.Department of Radiotherapy and OncologyPostgraduate Institute of Medical Education and ResearchChandigarhIndia
  2. 2.Department of PathologyPostgraduate Institute of Medical Education and ResearchChandigarhIndia
  3. 3.Department of Radiotherapy and OncologyAll India Institute of Medical SciencesNew DelhiIndia

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