The role of adjuvant chemotherapy in early-stage high-grade uterine leiomyosarcoma: A retrospective review.

Abstract

e15500 Background: Although the majority of patients with uterine leiomyosarcoma (ULMS) present with early stage disease, the risk of recurrence is high. Because ULMS is a rare disease, standardized adjuvant treatment options do not exist. Therefore, the goal of this study is to determine the role of adjuvant chemotherapy in patients with stages I-II high grade ULMS. Methods: Women with stages I-II ULMS treated at our institution from 1988-2008 were retrospectively identified and included in this study (N=44). Data was collected on patient age, stage of disease, surgical procedure, adjuvant treatment, recurrence, and survival. Results: In this population, 24 (55%) patients received cytotoxic chemotherapy, 3 (7%) received concurrent chemoradiation, 2 (4.5%) patients received radiation alone, and 15 (34%) received no further treatment. Median follow up for survivors was 71 months. In the no treatment and radiation alone groups, 71% of patients recurred and 29% were alive at last follow up. In the chemotherapy and chemoradiation groups, 63% of patients recurred and 48% were alive at last follow-up. There was also a difference noted based on type of chemotherapy received. Patients who received adriamycin and ifosfamide had a recurrence rate of 25%, and 63% were alive at last follow up. In the gemcitabine and docetaxel group, while 75% of these patients recurred, many of these recurrences were salvageable, thus 75% of patients were alive at last follow up. The five year survival rate for patients who received chemotherapy was 58% compared to 48% for those who did not receive chemotherapy (p=0.09). The five year survival rate for patients who received combination chemotherapy was 91% compared to 39% for patients who received single agent chemotherapy (p=0.07). Conclusions: Adjuvant chemotherapy, especially combination chemotherapy for early stage high grade ULMS in this series demonstrates a benefit and even a trend towards improved outcome.