Department of Radiation Oncology, Tianjin Medical University Cancer Institute& Hospital, Key Laboratory of Cancer Prevention and Therapy,National Clinical Research Center for Cancer,Tianjin 300060,China
Abstract：Objective To evaluated the role of postoperative radiotherapy (PR) after surgery in patients with uterine sarcoma,and analyzed the prognostic factors. Methods A total of 182 patients with uterine sarcoma were included between June 1994 and October 2014. Radiotherapy dose were 30-50 Gy/10-25 fractions/5 fractions/week. The LRFFS and OS were calculated with Kaplan-Meier method, and difference was analyzed with log-rank method. Cox regression analyses were used to determine prognosticators. Results There were 114 patients which survived more than 5-years in this whole group, including PR 24 cases and no PR 90 cases. The 5-year LRRFS and OS were 62.1% and 56.2%,respectively. The 5-year LRRFS were 78.0% and 55.3% on PR and no PR (P=0.013);with OS 64.1% and 51.7% on PR and no PR (P=0.070).A multivariate analysis showed that pathological types, histological grade and clinical stage were associated with LRRFS and OS (P=0.032,0.008, 0.000 and 0.046,0.000,0.000). PR was significant influencing factor for OS (P=0.013). Conclusions Uterine sarcoma patients treated with PR after surgery had an improved LRRFS compared to those treated with surgery,especially those with leiomyosarcoma. The role of PR personalized radiation for uterine sarcoma still needs to be further discussed.
[1]D’Angelo E,Prat J. uterine leiomyosarcomaomas:a review[J].Gynecol Oncol,2010,116(1):131-139.DOI:10.1016/j.ygyno.2009.09.023. [2]Khalid El-Khalfaoui,Andreas du Bois,et al. Current and future options in the management and treatment of uterine leiomyosarcomaoma[J]. Ther Adv Med Oncol,2014,6(1):21-28.DOI:10.1177/1758834013513314. [3]Olah KS, Gee H, Blunt S, et al. Retrospective analysis of 318 cases of uterine sarcoma[J]. Eur J Cancer,1991,27(9):1095-1099. [4]Major FJ, Blessing JA, Silverberg SG, et al. Prognostic factors in early-stage uterine sarcoma. A Gynecologic Oncology Group study[J]. Cancer,1993,71(4 Suppl):1702-1709. [5]Callister M, Ramondetta LM, Jhingran A, et al. Malignant mixed Mullerian tumors of the uterus:analysis of patterns of failure, prognostic factors, and treatment outcome[J]. Int J Radiat Oncol Biol Phys,2004,58(3):786-796.DOI:10.1016/S0360-3016(03)01561-X. [6]Sorbe B, Johansson B. Prophylactic pelvic irradiation as part of primary therapy in uterine sarcomas[J]. Int J Oncol,2008,32(5):1111-1117. [7]Moskovic E, Macsweeney E, Law M, et al. Survival, patterns of spread and prognostic factors in uterine sarcoma:a study of 76 patients[J]. Br J Radiol,1993,66(791):1009-1015. [8]高琨,李力. 子宫肉瘤术后的辅助治疗[J]. 实用妇产科杂志,2012(01):13-15. Gao K,Li L. The postoperative adjuvant therapy of Uterine sarcoma[J]. J Pract Obstet Gynecol, 2012(01):13-15. [9]Wright JD, Seshan VE, Shah M, et al. The role of radiation in improving survival for early-stage carcinosarcoma and leiomyosarcoma[J]. Am J Obstet Gynecol,2008,199(5):531-536.DOI:10.1016/j.ajog.2008.04.019. [10]Sampath S, Schultheiss TE, Ryu JK, et al. The role of adjuvant radiation in uterine sarcomas[J]. Int J Radiat Oncol Biol Phys,2010,76(3):728-734.DOI:10.1016/j.ijrobp.2009.02.077. [11]Reed NS, Mangioni C, Malmstrom H, et al. 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)[J]. Eur J Cancer,2008,44(6):808-818.DOI:10.1016/j.ejca.2008.01.019. [12]Bodner K, Bodner-Adler B, Obermair A, et al. Prognostic parameters in endometrial stromal sarcoma:a clinicopathologic study in 31 patients[J]. Gynecol Oncol 2001;81(2):160-165.DOI:10.1006/gyno.2001.6152. [13]Gadducci A, Sartori E, Landoni F, et al. Endometrial stromal sarcoma:analysis of treatment failures and survival[J]. Gynecol Oncol,1996,63(2):247-253.DOI:10.1006/gyno.1996.0314. [14]Leath CR, Huh WK, Hyde JJ, et al. A multi-institutional review of outcomes of endometrial stromal sarcoma[J]. Gynecol Oncol,2007,105(3):630-634.DOI:10.1016/j.ygyno.2007.01.031. [15]Weitmann HD, Knocke TH, Kucera H, et al. Radiation therapy in the treatment of endometrial stromal sarcoma[J]. Int J Radiat Oncol Biol Phys,2001,49(3):739-748. [16]Barney B, Tward JD, Skidmore T, et al. Does radiotherapy or lymphadenectomy improve survival in endometrial stromal sarcoma?[J]. Int J Gynecol Cancer,2009,19(7):1232-1238.DOI:10.1111/IGC.0b013e3181b33c9a.
2016, Vol. 25 
