Postoperative radiotherapy improves local control and survival in patients with uterine leiomyosarcoma

Radiation Oncology

Michael Milosevic³  Wilfred Levin²  Lee Manchul²  Anthony Fyles²  Stephane Laframboise⁴  Charles Catton²  Jenna Sykes¹  Kathy Han²  Philip Wong² 

[1] Department of Biostatistics, Princess Margaret Cancer Centre, University of Toronto, 610 University Avenue, Toronto, ON M5G 2M9, Canada;Department of Radiation Oncology, University of Toronto, Fitzgerald Building, 150 College Street, Toronto, ON M5S 3E2, Canada;Radiation Medicine Program, Princess Margaret Cancer Centre, 5th Floor Rm 985, 610 University Avenue, Toronto, ON M5G 2M9, Canada;Department of Gynaecologic Oncology, Princess Margaret Cancer Centre, University of Toronto, 610 University Avenue, Toronto, ON M5G 2M9, Canada

关键词: Survival;    Recurrence;    Competing risk;    Leiomyosarcoma;    Uterine;    Radiotherapy;   

Others  :  1153871
DOI  :  10.1186/1748-717X-8-128

 received in 2013-02-18, accepted in 2013-05-22,  发布年份 2013

【 摘 要 】

Background

To examine the role of radiotherapy (RT) in uterine leiomyosarcomas (LMS) and to determine the patient population who may benefit from RT.

Methods

From 1998–2008, 69 patients with primary uterine LMS underwent hysterectomy with or without pelvic radiotherapy to a median dose of 45 Gy. Univariate analysis was performed using the Kaplan-Meier method and cumulative-incidence function, and multivariate analyses using Fine and Gray or Cox proportional hazard models.

Results

Following surgery, 32 out of 69 patients received RT. There was no evidence of any correlation between patient, disease and treatment characteristics and the use of RT. Median follow-up was 57 months. RT was associated with reduced local recurrence (3y LR 19% vs. 39%; Gray’s p = 0.019) and improved overall survival (3y OS 69% vs. 35%; log-rank p = 0.025) on univariate analysis. Multivariate analysis demonstrated that RT reduced LR (HR: 0.28, CI: 0.11-0.69, p = 0.006) and increased OS (HR: 0.44, CI: 0.23-0.85, p = 0.014) independent of other clinical and pathologic factors. Positive surgical margins increased the odds of LR (HR: 5.6, CI: 2.3-13.4, p = 0.00012). Large tumor size and advanced stage (II-IV) were associated with the development of distant metastases and inferior OS.

Conclusions

Postoperative pelvic RT reduces LR and improves OS of patients with uterine LMS.

【 授权许可】

   
2013 Wong et al.; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]D’Angelo E, Prat J: Uterine sarcomas: a review. Gynecol Oncol 2010, 116:131-139.
• [2]Giuntoli RL 2nd, Metzinger DS, DiMarco CS, Cha SS, Sloan JA, Keeney GL, Gostout BS: Retrospective review of 208 patients with leiomyosarcoma of the uterus: prognostic indicators, surgical management, and adjuvant therapy. Gynecol Oncol 2003, 89:460-469.
• [3]Zivanovic O, Leitao MM, Iasonos A, Jacks LM, Zhou Q, Abu-Rustum NR, Soslow RA, Juretzka MM, Chi DS, Barakat RR: Stage-specific outcomes of patients with uterine leiomyosarcoma: a comparison of the international Federation of gynecology and obstetrics and american joint committee on cancer staging systems. J Clin Oncol 2009, 27:2066-2072.
• [4]Garg G, Shah JP, Liu JR, Bryant CS, Kumar S, Munkarah A, Morris RT: Validation of tumor size as staging variable in the revised international federation of gynecology and obstetrics stage I leiomyosarcoma: a population-based study. Int J Gynecol Cancer 2010, 20:1201-1206.
• [5]Mahdavi A, Monk BJ, Ragazzo J, Hunter MI, Lentz SE, Vasilev SA, Tewari KS: Pelvic radiation improves local control after hysterectomy for uterine leiomyosarcoma: a 20-year experience. Int J Gynecol Cancer 2009, 19:1080-1084.
• [6]Reed NS, Mangioni C, Malmstrom H, Scarfone G, Poveda A, Pecorelli S, Tateo S, Franchi M, Jobsen JJ, Coens C: Phase III randomised study to evaluate the role of adjuvant pelvic radiotherapy in the treatment of uterine sarcomas stages I and II: an european organisation for research and treatment of cancer gynaecological cancer group study (protocol 55874). Eur J Cancer 2008, 44:808-818.
• [7]Zivanovic O, Jacks LM, Iasonos A, Leitao MM Jr, Soslow RA, Veras E, Chi DS, Abu-Rustum NR, Barakat RR, Brennan MF, Hensley ML: A nomogram to predict postresection 5-year overall survival for patients with uterine leiomyosarcoma. Cancer 2012, 118(3):660-9. Epub 2011 Jul 12
• [8]Kim WY, Chang SJ, Chang KH, Yoon JH, Kim JH, Kim BG, Bae DS, Ryu HS: Uterine leiomyosarcoma: 14-year two-center experience of 31 cases. Cancer Res Treat 2009, 41:24-28.
• [9]Park JY, Park SK, Kim DY, Kim JH, Kim YM, Kim YT, Nam JH: The impact of tumor morcellation during surgery on the prognosis of patients with apparently early uterine leiomyosarcoma. Gynecol Oncol 2011, 122:255-259.
• [10]Prat J: FIGO staging for uterine sarcomas. Int J Gynaecol Obstet 2009, 104:177-178.
• [11]Enneking WF, Spanier SS, Goodman MA: A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop Relat Res 1980, 106-120.
• [12]Fine JPGR: A proportional hazards model for the subdistribution of a competing risk. J Am Stat Assoc 1999, 94:496-509.
• [13]Dinh TA, Oliva EA, Fuller AF Jr, Lee H, Goodman A: The treatment of uterine leiomyosarcoma. Results from a 10-year experience (1990–1999) at the Massachusetts General Hospital. Gynecol Oncol 2004, 92:648-652.
• [14]Major FJ, Blessing JA, Silverberg SG, Morrow CP, Creasman WT, Currie JL, Yordan E, Brady MF: Prognostic factors in early-stage uterine sarcoma. A Gynecologic Oncology Group study. Cancer 1993, 71:1702-1709.
• [15]Nordal RR, Kristensen GB, Kaern J, Stenwig AE, Pettersen EO, Trope CG: The prognostic significance of stage, tumor size, cellular atypia and DNA ploidy in uterine leiomyosarcoma. Acta Oncol 1995, 34:797-802.
• [16]International Union Against Cancer. Committee on Tumor Nomenclature [from old catalog]: Die Klassifizierung der malignen Tumoren nach dem TNM System. Berlin, New York: Springer-Verlag; 1970.
• [17]Gronchi A, Casali PG, Mariani L, Miceli R, Fiore M, Lo Vullo S, Bertulli R, Collini P, Lozza L, Olmi P, Rosai J: Status of surgical margins and prognosis in adult soft tissue sarcomas of the extremities: a series of patients treated at a single institution. J Clin Oncol 2005, 23:96-104.
• [18]Stoeckle E, Coindre JM, Bonvalot S, Kantor G, Terrier P, Bonichon F, Nguyen Bui B: Prognostic factors in retroperitoneal sarcoma: a multivariate analysis of a series of 165 patients of the French Cancer Center Federation Sarcoma Group. Cancer 2001, 92:359-368.
• [19]Stojadinovic A, Leung DH, Hoos A, Jaques DP, Lewis JJ, Brennan MF: Analysis of the prognostic significance of microscopic margins in 2,084 localized primary adult soft tissue sarcomas. Ann Surg 2002, 235:424-434.