Anthracycline-based and gemcitabine-based chemotherapy in the adjuvant setting for stage I uterine leiomyosarcoma: a ret
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linical Sarcoma Research Open Access
RESEARCH
Anthracycline‑based and gemcitabine‑based chemotherapy in the adjuvant setting for stage I uterine leiomyosarcoma: a retrospective analysis at two reference centers Giovanni Fucà1, Chiara Fabbroni1, Rosanna Mancari2, Sara Manglaviti1, Giorgio Bogani3, Elena Fumagalli1, Rossella Bertulli1, Carlo Morosi4, Paola Collini5, Francesco Raspagliesi3, Nicoletta Colombo2,6, Paolo G. Casali1,7 and Roberta Sanfilippo1*
Abstract Background: Radically resected early uterine leiomyosarcoma (eULMS) is still marked by a poor prognosis. Adjuvant strategies investigated up to now have not been corroborated by controlled studies. We retrospectively reviewed the clinical outcome of eULMS patients treated with adjuvant anthracycline-based or gemcitabine-based chemotherapy at two Italian reference centers. Methods: In this explorative, retrospective, cohort analysis, we included all the consecutive patients with radically resected eULMS treated at two centers between 1997 and 2017. Results: A total of 109 consecutive patients were included. Sixty-six (60%) received an anthracycline-based regimen, whereas 43 (40%) received a gemcitabine-based regimen. Median disease-free survival (DFS) was 41.3 months with anthracycline-based regimens compared to 20.9 months with gemcitabine-based regimens (HR: 0.49; 95% CI: 0.30–0.80; P = 0.004). In the multivariable model, anthracycline-based regimens were independently associated with a better DFS. No difference in terms of overall survival was observed. Conclusions: DFS was not the same by using an anthracycline-based or a gemcitabine-based adjuvant chemotherapy for patients with radically resected eULMS. The results of our study are in line with recent prospective controlled evidence in limb and superficial trunk soft tissue sarcomas. The role of anthracycline-based adjuvant chemotherapy should still be viewed as a research issue in eULMS. Keywords: Uterine leiomyosarcoma, Adjuvant chemotherapy, Gemcitabine, Anthracycline Background Uterine leiomyosarcoma (ULMS) represents 1–2% of all uterine neoplasms. It is the most common type of uterine sarcomas, with an incidence of about 0.55/100,000 women per year [1]. Surgery is considered the mainstay *Correspondence: [email protected] 1 Medical Oncology Unit 2, Medical Oncology Department, Fondazione IRCCS Istituto Nazionale Dei Tumori Di Milano, Milan, Italy Full list of author information is available at the end of the article
treatment in uterine-confined ULMS (FIGO stage I) [2], avoiding procedures associated with a possible tumor spillage (i.e. morcellation) that are discouraged by guidelines because of the negative impact on patients’ prognosis [3, 4]. Regrettably, ULMS is characterized by a poor prognosis even if diagnosed at an early stage [5]. Until now, unfortunately, adjuvant strategies investigated failed to be demonstrated to improve overall survival. Radiation therapy did not add any benefit to surgery alone in a large randomized trial [6], in spite of
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