Περίληψη:
Introduction: The purpose of the present prospective study was to evaluate prognosis (survival, recurrence rates) and other prognostic and epidemiologic factors regarding uterine sarcomas, after the application of a specific therapeutic protocol. Patients or Methods: This protocol included radical cytoreduction surgery and adjuvant chemotherapy with multiple agents (ifosfamide, etoposide, doxorubicin, MESNA). The study included 36 patients with no recessive or progressive disease after surgery. 22 of the cases (61%) were mixed mullerian tumors, 10 (28%) were leiomyosarcomas and 4 (11%) other types. Results: Mean age of appearance was 63.5 years for mixed mullerian tumors, 52.8 for leiomyosarcoma and 38.7 for other types, a difference that was significant (p = 0.008). Additionally, the proportion of premenopausal patients was significantly increased among tumors with other histological types. After a median 61.5 months follow-up, we registered as median survival rate 46.8 months and as median disease free period 29.5 months in total. This clinical outcome is considered as satisfactory, taking in mind the tumors' aggressiveness. Per histological type, median survival rate was 46.8 months for mixed mullerian tumors and 44.1 months for leiomyosarcoma, a difference which was not significant. On the contrary, patients with leiomyosarcoma relapsed more rapidly than patients with mixed mullerian tumors and other types and this difference was significant (p = 0.01).Therefore, the leiomyosarcoma appears to be the most aggressive histologic type among uterine sarcomas. Stage at presentation (early I, II vs. advanced III, IV) was not proved to be of statistical significance regarding survival and recurrence rates, obviously because of the relatively high survival and disease free period rates achieved among advanced stage patients, possibly due to recurrence successful chemotherapy treatment after radical surgery. In mixed mullerian tumors vascular invasion and the presence of heterologous elements does not affect clinical outcome, although we observed a clear tendency for a worse prognosis in the last case. Conclusions: Despite tumor's aggressiveness and low survival and disease free period rates, a complex therapeutic protocol application which includes radical surgical cytoreduction and adjuvant postoperative chemotherapy with multiple therapeutic regiments, may contribute to higher survival and recurrence free rates. Adjuvant radiotherapy doesn't seem to improve clinical outcome. Leiomyosarcoma seems to be the most aggressive histological type among female genital tract sarcomas, since it rapidly relapses. © Georg Thieme Verlag KG Stuttgart.
Συγγραφείς:
Zafeiriou, S.
Papadimitriou, Ch.
Markaki, S.
Voulgaris, Z.
Vlachos, G.
Rodolakis, A.
Zervoudis, S.
Diakomanolis, E.
Antsaklis, A.
Schindler, A.E.
Λέξεις-κλειδιά:
doxorubicin; etoposide; ifosfamide; mesna, adjuvant therapy; adolescent; adult; advanced cancer; aged; article; cancer chemotherapy; cancer classification; cancer growth; cancer recurrence; cancer relapse; cancer risk; cancer staging; clinical study; controlled study; cytoreductive surgery; disease free survival; female; histopathology; human; human tissue; leiomyosarcoma; major clinical study; mixed Mullerian tumor; multiple cycle treatment; patient satisfaction; premenopause; prognosis; prospective study; treatment outcome; uterus sarcoma
