Abstract
ObjectiveLow-grade endometrial stromal sarcoma (LG-ESS) is a rare gynecological tumor. Whether adjuvant radiotherapy benefits survival in patients with resected early-stage ESS remains controversial. This study was designed to explore the role of adjuvant radiotherapy in stage I to II LG-ESS.MethodsWe retrospectively reviewed patients with stage I to II LG-ESS in our center from Jan. 1998 to Feb. 2018. All patients underwent a total hysterectomy and postoperative radiotherapy was administrated based on clinical and pathological characteristics.ResultsA total of 152 patients with stage I to II resected LG-ESS were included. Forty patients received adjuvant radiotherapy (RT group) while 112 patients did not receive adjuvant radiotherapy (no RT group). The baseline characteristics of the two groups were comparable, except that the proportion of stage II patients in the RT group was higher than that in the no RT group (32.5% vs. 11.6%, in RT vs. no RT groups, respectively; p = 0.003). For both patient groups, median overall survival was not reached. The median disease-free survival (DFS) was 144 months. Radiotherapy was associated with significantly improved DFS (92 months vs. not reached in RT vs. no RT groups, respectively; p = 0.008) and pelvic failure-free survival (PFFS) (92 months vs. not reached in RT vs. no RT groups, respectively; p=0.004). Subgroup analysis revealed that RT benefited survival most among patients with stage IB to IIB disease. Adjuvant radiotherapy significantly reduced the pelvic recurrence rate (10.0%, 4/40 vs. 28.6%, 32/112, p = 0.018). No radiotherapy-induced grade 4 to 5 toxicity was observed.ConclusionFor patients with stage I to II LG-ESS, adjuvant radiotherapy showed significant improvement in DFS and PFFS with tolerable adverse effects, especially in patients with stage IB to IIB disease.
Highlights
Uterine sarcoma (US) is a malignant mesenchymal tumor that accounts for approximately 1% of female genital tract malignancies and 3% to 7% of all uterine tumors [1, 2]
Eighteen of the 34 underwent total hysterectomy because of preoperative diagnosis of uterine fibroids and second surgery was refused by patients despite the diagnosis of low-grade endometrial stromal sarcoma (LG-ESS)
Most patients were in Federation of Gynecology and Obstetrics (FIGO) stage I (126/152, 82.9%, including stage IA, 39/152 and stage IB, 87/152)
Summary
Uterine sarcoma (US) is a malignant mesenchymal tumor that accounts for approximately 1% of female genital tract malignancies and 3% to 7% of all uterine tumors [1, 2]. US includes low-grade endometrial stromal sarcoma (LG-ESS), high-grade endometrial stromal sarcoma, undifferentiated uterine sarcoma, and uterine leiomyosarcoma. After surgery, the pelvic recurrence rate in patients with ESS is as high as 10%–30% [3, 5, 6] indicating that current approaches might not be sufficient to completely eradicate pelvic disease. Radiotherapy on postoperative LG-ESS patients consists of external beam radiotherapy to the pelvis to eliminate microscopic disease in the pelvic area and intracavitary brachytherapy to the vaginal cuff. Due to the rarity of LGESS, no data about the efficacy of adjuvant RT are available from prospective randomized controlled clinical trials [7]. This study was designed to evaluate the efficacy of RT on the long-term outcomes of patients with early-stage low-grade endometrial stromal sarcoma in a high-volume center
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