UTERINE LEIOMYOSARCOMA - ANALYSIS OF TREATMENT FAILURES AND SURVIVAL

The objective of this retrospective multicenter study was to assess th e rates, times, and sites of recurrences of 126 patients with uterine leiomyosarcomas. Surgery was the initial therapy for all patients. Med ian follow-up of survivors was 50 months (range, 3-168 months), Of the 90 patients with stage I-II disease, 26 received postoperative irradi ation and/or chemotherapy, Thirty-five (38.9%) patients developed recu rrent disease after a median time of 16 months (range, 2-102 months). Recurrence was pelvic in 5 (14.3%) patients, distant in 23 (65.7%), an d pelvic plus distant in 7 (20.0%). The overall recurrence rate was si milar in patients who received adjuvant treatment and in those who did not. None of the 15 patients who underwent pelvic irradiation develop ed local recurrences, but 5 of them failed in distant sites. Of the 16 patients with stage III leiomyosarcomas, 2 died of intercurrent disea se within 1 month from surgery and 11 received postoperative irradiati on and/or chemotherapy. Thirteen patients developed recurrent tumor af ter a median time of 8 months (range, 1-21 months). Recurrence was pel vic in 3, distant in 4, and pelvic plus distant in 6 patients. Of the 20 patients with stage IV leiomyosarcomas, after surgery 6 were clinic ally free of disease (group A) and 14 had clinically evaluable residua l disease (group B). With regard to group A, 3 patients received posto perative irradiation and/or chemotherapy. Five patients developed recu rrent disease after a median time of 11 months (range, 8-16 months). R ecurrence was distant in 3 patients and pelvic plus distant in 2. With regard to group B, 11 patients underwent postoperative chemotherapy. Eleven patients died after a median time of 6 months (range, 1-15 mont hs), and 3 are still alive with clinical evidence of disease after 4, 5, and 8 months, respectively, from surgery. Cox model showed that sta ge (P = 0.0001), mitotic count (P = 0.0002), and age (P = 0.0048) were independent prognostic variables for disease-free survival. In conclu sion, uterine leiomyosarcomas have an aggressive clinical behavior, wi th a propensity to recur both locally and moreover at distant sites, T umor stage is the strongest prognostic variable, Only patients with ea rly-stage disease have a chance of surviving, whereas the treatment of patients with advanced or recurrent disease is palliative. (C) 1996 A cademic Press, Inc.