Radiation therapy in the treatment of endometrial stromal sarcoma.
OBJECTIVE
The efficacy of radiation therapy in the treatment of endometrial stromal sarcoma (ESS) is still not clear. We report our results over an 18-year period in comparison to data from literature concerning adjuvant radiation therapy and other treatment modalities.


METHODS
During 1981-1998, 21 patients with ESS were treated at General Hospital Vienna. The age of the patients ranged between 44-76 years (median: 65 yr). The 1989 FIGO classification for endometrial carcinoma was used in this study retrospectively. Eleven patients presented in Stage I, 1 in Stage II and 5 in Stage III. Four patients had Stage IV tumors or recurrences. The majority of patients (66.7%) had a Grade 3 tumor. Seventeen patients were treated in a curative intent. Fifteen patients were referred for postoperative radiotherapy after hysterectomy. Thirteen of them received a combined radiotherapy. Two patients were referred for primary radiotherapy. They received a combined radiotherapy. Four patients were referred for radiotherapy with a palliative intent. Twenty patients received external beam therapy (EBT) in daily fractions of 1.6-2.0 Gy up to a total dose of 27-57 Gy to the pelvis. Seventeen patients received brachytherapy.


RESULTS
Follow-up was 8 to 170 months (mean: 70.3 months, median: 64 months). Eleven patients are still alive, 10 without tumor and 1 with tumor. Ten patients are dead, 6 due to ESS, 1 due to breast cancer, and 3 due to intercurrent diseases. After adjuvant radiotherapy, 3 patients had tumor recurrences. All had distant metastases, and 1 had local failure additionally. Two patients with primary treatment died due to intercurrent disease without tumor. The overall actuarial survival and the disease-specific survival rates were 63.4% and 80.9% after 5 years and 52.8% and 80.9% after 10 years. The overall local control rate was 93.8% after 5 years. Four patients treated with a palliative intent showed partial response. Three patients died rapidly due to tumor. One patient with a Grade 1 tumor is still alive 12 months after treatment.


CONCLUSIONS
In our experience, surgery and adjuvant radiation therapy are most effective treatments for patients with ESS due to the excellent local control in all stages and the good disease-specific survival in early stages.
Weitmann
H D
HD
Department of Radiotherapy and Radiobiology, University of Vienna at the General Hospital Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria. Dirk.Weitmann@str.akj.magwien.gv.at
Knocke
T H
TH
Kucera
H
H
Pötter
R
R
D000328:Adult; D000367:Age Factors; D000368:Aged; D017024:Chemotherapy, Adjuvant; D016001:Confidence Intervals; D016889:Endometrial Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009367:Neoplasm Staging; D010166:Palliative Care; D011878:Radiotherapy / Q000009:adverse effects; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D018203:Sarcoma, Endometrial Stromal / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy*; D016019:Survival Analysis