Uterine sarcomas: a review of the Edinburgh experience from 1974 to 1992

Abstract

A retrospective review of patients treated for a uterine sarcoma in Edinburgh from 1974 to 1992 has been performed. Clinical details at presentation, tumour pathology, treatment and the outcome of treatment were all recorded. 82 patients' case notes were reviewed. 54 patients had died and 28 were alive (mean follow-up period 80.3 months). 39 patients had a malignant mixed mesodermal tumour, 12 patients had an endometrial stromal sarcoma, and 27 had a leiomyosarcoma. Using a modified FIGO staging retrospectively, 41 patients had Stage 1 disease, two patients had Stage 2, 16 patients had Stage 3, and 13 patients had Stage 4 disease. Definitive treatment of total abdominal hysterectomy and bilateral salpingo-oophorectomy was used in 69 patients, with 35 of these patients also receiving post-operative radiotherapy to the pelvis. 13 patients did not undergo surgery. Five of these patients received radical radiotherapy, three patients received palliative radiotherapy, and five patients were not treated. The overall median survival is 15 months and the 5-year actuarial survival is 31%. 25 of the 26 surviving patients had Stage 1 disease at presentation. Post-operative pelvic radiotherapy did not influence either survival or local tumour control. 51 of the 54 patients who relapsed had evidence of distant metastases. We conclude that total abdominal hysterectomy and bilateral salpingo-oophorectomy remains the treatment of choice for uterine sarcomas.

Radiotherapy in the Treatment of Uterine Sarcomas

“…As in endometrial cancer it has been observed that in US survival relates to initial stage [1,5,9]. In common with these data we observed an improved prognosis for low stage and especially for low histological tumor grad ing.…”

“…From the data in the literature there is no prospective randomized trial available to demonstrate improved sur vival after XRT for any type of US in the long term [6,7,9], In our series we found an increased overall survival at 5 years in group B as compared to group A (90% group B vs. 34% group A). The positive results in our analysis however might at least partially be biased by the high pro portion of patients with ESS in group B of whom neither in group A nor group B relapsed.…”

“…It has been discussed in the literature how the addition of radiotherapy to surgery alters the pattern of failure [7][8][9], It is known from the behavior of US that the incidence of isolated pelvic recurrence is low. Salazar et al [10] found pelvic recurrence alone only in 14% of their patients, while that of pelvic plus distant failure was 65-75%.…”

“…Gynecol Obstct Invest 1996:42:49-57 py should be added to percutaneous irradiation [4,7,9,10]. According to the biological behavior of US reported from large series it is known that the whole abdominal cavity is at risk for relapse [1,3,11].…”

Sarcomas Uterinos: Manejo Actual

“…Representan un grupo heterogéneo de neoplasias que se desarrollan del miometrio (leiomiosarcomas) y desde la mucosa uterina (sarcomas del estroma endometrial y sarcomas mesodér-micos mixtos) (2). Tienen un pronóstico pobre con una sobrevida global en general menor del 50% a 2 años, incluso en etapas tempranas de la enfermedad (3,4,5). Debido a la rareza de este tumor, así como también a su diversidad patológi-ca no existen estudios prospectivos randomizados fase III, por lo que las recomendaciones de tratamiento deben ser basadas en revisiones retrospectivas de pequeñas series, lo que asociado a su mal pronóstico hacen difícil su manejo clínico.…”