ESTRO 2023

Session Item

Gynaecological

Session Type: Poster (Digital)

Track: Clinical

Journey:

Treatment outcomes in Uterine Sarcomas: A Real-world experience

Srinivasa GY, India

Presentation Number: PO-1428

Abstract

Abstract Title:

Treatment outcomes in Uterine Sarcomas: A Real-world experience

Authors:

Srinivasa GY¹, Bhavana Rai¹, Treshita Dey¹, Radhika Srinivasan², Vanita Jain³, Vanita Suri³, Rashmi Bagga³, Sushmita Ghoshal¹

¹Post Graduate Institute of Medical Education and Research, Radiotherapy and Oncology, Chandigarh, India; ²Post Graduate Institute of Medical Education and Research, Gynae-pathology, Chandigarh, India; ³Post Graduate Institute of Medical Education and Research, Obstretics and Gynaecology, Chandigarh, India

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Purpose or Objective

To evaluate clinicopathologic characteristics and prognostic factors of uterine Sarcomas and to assess the patterns of relapse and survival.

Material and Methods

It is a single-institution retrospective analysis of histopathologically confirmed uterine sarcoma, including Leiomyosarcoma (LMS) & endometrial stromal sarcoma (ESS) treated in our institute from 2015-2021. A total of 81 patients were included. Kaplan Meier and log-rank tests were used for survival analysis. The Cox regression model was used to determine prognostic factors.

Results

The most common histopathological type was ESS (49/81, 60.4%), followed by LMS (32/81, 39.6%). The median age at diagnosis was 50 years for LMS and 41 years for ESS. A total of 80 (98.7%) patients (31 for LMS and 49 for ESS) underwent surgery. Eighteen (56.2%) patients were early stage (FIGO stage 1& 2), 14 (43.75%) were advanced stage (3 & 4) for LMS. Thirty (61.1%) patients were early stage & 14 (28.6%) were in the advanced stage of ESS. Twelve patients (37.5%) for LMS and 9 (18.3) for ESS had positive surgical margins. In the case of LMS, ten patients (31.3%) received adjuvant External Beam Radiation (EBRT), and 17 (53%) received chemotherapy (Table1). In the case of ESS, 20 patients (40.8%) received pelvic EBRT, and 14 (28.5%) received chemotherapy. The most common pattern of failure for LMS was distant relapse (21, 65.6%) followed by local relapse (8, 25%), and for ESS, eight patients (16.3%) had a distant relapse, and 7 (14.2%) had a loco-regional relapse. Median overall survival (OS) was 19 months, progression-free survival (PFS) was 11 months, 2-year OS was 45.9%, and 2-year PFS was 34.6% for LMS. In the case of ESS, 2-year OS was 83%, and 2-year PFS was 76% (Figure1). The tumor stage (p=0.02), size of the tumor (p=0.02) for LMS and Low grade (p=0.03), and positive margins (p=0.01) for ESS were significantly associated with PFS.

Table1: Patient and Treatment characteristics of Uterine Sarcomas

Patient & treatment characteristics	LMS (n=32)	ESS (n=49)
Median age (Range)	50 years (36-72 years)	41 years (20-71 years)
Menopause attained	16 (50%)	15 (30.6%)
FIGO stage 1&2 3&4	18(56.25%) 14(43.75%)	30(61.1%) 19(38.9%)
Grade Low-grade ESS High-grade ESS		27(55%) 22(45%)
Primary surgery	31(96.9)	49(100%)
Positive surgical margin	12 (37.5%)	9(18.3%)
Pelvic EBRT	10(31.3)	20 (40.8%)
Chemotherapy	17(53.1%)	14 (28.5%)

Figure1: Survival curves for PFS and OS

Conclusion

Uterine sarcomas are relatively rare. Advanced stage, large tumor, suboptimal surgery, metastasis and LVSI were associated with unfavourable prognosis in LMS. The grade of tumor and positive margins were associated with an unfavourable prognosis in ESS. This study emphasises the role of multi-modality treatment in the form of Surgery, Radiation and chemotherapy.