The role of postoperative radiotherapy in uterine sarcomas: a single institution analysis.
PO-1563
Abstract
The role of postoperative radiotherapy in uterine sarcomas: a single institution analysis.
Authors: Maria Cerrolaza1, Agustina Mendez1, Victoria Navarro1, Alberto Lanuza1, Anabela Miranda2, Arantxa Campos1, Marina Gascon3, Jose Miguel Ponce4, Reyes Ibañez4
1University Hospital Miguel Servet , Radiation Oncology, ZARAGOZA, Spain; 2National Oncological Institute "Dr. Juan Tanca Marengo" (SOLCA), Radiation Oncology, Guayaquil, Ecuador; 3University Clinical Hospital Lozano Blesa, Radiation Oncology, ZARAGOZA, Spain; 4University Hospital Miguel Servet, Radiation Oncology, ZARAGOZA, Spain
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Purpose or Objective
Uterine sarcomas (US) are rare malignant tumours arising from the smooth muscle or connective tissue of the uterus which account for only 3 to 7% of uterine malignancies but are the most common cause of uterine cancer-specific death. The most represented histological subtypes are leiomyosarcoma (LMS), endometrial stromal sarcoma (ESS), adenosarcoma (AS) and undifferentiated uterine sarcoma (USS). Uterine carcinosarcoma has been excluded from US classification as considering biphasic neoplasms (epithelial and mesenchymal elements), a subtype of high-grade endometrial sarcomas. The present study aimed to evaluate the effect of adjuvant radiotherapy on relapse and overall survival in patients with uterine sarcomas in our institution.
Material and Methods
41 patients who were diagnosed with uterine sarcoma and underwent hysterectomy were identified during the period from 2010 to 2021. After excluding patients with carcinosarcoma, 29 patients were included in the final analysis. Anatomopathological features, adjuvant treatments, dates and site of recurrence were collected. Univariate and multivariate analyses have been carried out.
Results
Mean age was 58.6 years. There were 17 LMS, 6 EES, 4 AS and 2 USS. FIGO stage at diagnosis was FIGO I, 18 patients; II, 3; III, 2 and IV, 6 patients. After surgery, 15 patients (51.7%) received adjuvant chemotherapy (CT) and 16 (55.17%) adjuvant radiotherapy (RT).
21 patients (72.4%) presented some type of recurrence with a mean time of onset of 24 months, of which three were loco regional, 17 distant (81%) and 1 patient both. The most frequent sites of distant metastases were pulmonary (58.8%) and carcinomatosis (29.4%).
With a median follow-up of 43 months, 11 patients have died 10 cancer-specific (34.48%) with a mean of 36 months from the time of diagnosis. Currently 15 patients have stable disease and 3 patients are in progression.
No statistically differences were found between histology, FIGO stage or adjuvant QT and the appearance of recurrence, time or location (loco regional or distant). Nor were differences found between these factors and death or time to death
Statistically significant differences were found between the appearance of recurrence and RT (p = 0.003) with no differences between location or death. In the analysis by histology, differences were found in the LMS in favour of the administration of adjuvant RT both in the occurrence of recurrence (p=0.026) and death (p=0.036).
These differences may be due to patient selection biases since it is those diagnosed in localized stages in which adjuvant RT were administered.
Conclusion
Postoperative radiotherapy in our series appear to reduce the chance of tumour recurrence with the potential to improve overall survival in selected histology.