THE VALUE OF RADIATION THERAPY IN LEIOMYOSARCOMA OF THE UTERUS.

Abstract

Most reports on uterine leiomyosarcoma state that the lesion is radioresistant (1, 2, 4, 5, 7–10), although significant palliation by radiotherapy to metastatic deposits or to local recurrences following surgical extirpation of uterus, tubes, and ovaries has been described (6). The authors will here summarize pertinent clinical facts about this lesion and detail 4 cases treated at Jefferson Medical College Hospital (Philadelphia), in each of which irradiation appears to have given worthwhile palliation. Incidence In reported series of uterine sarcomas, the leiomyosarcomas make up from 50 to 90 per cent of the total (1–4). Table I lists comparative numbers from three authors. Important also is the question of incidence of sarcomatous degeneration in the benign leiomyomas. Figures vary from 0.13 per cent reported by Corscaden (1) to 0.76 per cent by Kimbrough (12). Vogt reports an incidence of 0.41 per cent in 72,000 cases of myoma (13). No author claims more than 1 per cent, and several factors would appear to operate to reduce this relationship appreciably further, viz: 1. Not all uterine sarcomas are leiomyosarcomas, as illustrated in Table I. Thus many of the earlier reports on incidence of sarcomatous degeneration of fibroids give an overall figure without indicating how many of these lesions were actually indexed mesodermal tumors, stromal sarcoma, etc., all of which can be coincidentally associated with fibroid tumors. 2. There is an appreciable incidence of leiomyosarcoma arising from the myometrium without any associated “fibroids.” Nine of Corscaden's 32 cases did not originate in a myoma; 15 of Aaro's 40 did not (5). 3. A very few “benign” myomas recur or metastasize. 4. There is a serious question as to the validity of the histologic diagnosis of leiomyosarcoma when based on cellular atypism only. Where there is no evidence of invasion of the surrounding myometrium, the tumor is harmless (1). This has been described as a form of “pathologist's cancer” or as the sarcomatous equivalent of carcinoma in situ. Age and Parity The predominant age among patients with uterine leiomyosarcoma is forty through sixty. The authors surveyed listed age ranges of thirty to seventy-four, with a mean of about forty-nine (Corscaden). There is no apparent relation to parity. Total offspring ranged from 0 to 12 in Aaro's series; 45 of his 53 patients were married and 12 of these were nulliparous. Relation to Previous Irradiation Of Aaro's 53 patients, 9 gave a history of previous radium or roentgen therapy to the pelvic organs. In 4 of the 9, tumors were present at the time of irradiation. In the other 5 there was a lapse of fourteen months to six years after irradiation before diagnosis of the uterine sarcoma.