Systemic therapy for advanced uterine sarcoma: a systematic review of the literature.
OBJECTIVE
To conduct a systematic review of the literature regarding the systemic treatment of advanced uterine sarcoma and provide an evidence-based summary of the available literature.


METHODS
MEDLINE, EMBASE, and the Cochrane Library databases were searched. "Uterine sarcoma," "leiomyosarcoma," "mixed mesodermal tumor," "chemotherapy," and "systemic therapy" were combined with the search terms for study designs.


RESULTS
Three randomized controlled trials and 24 prospective phase II trials were included in the systematic review. In a randomized trial of doxorubicin versus doxorubicin plus cyclophosphamide for advanced or recurrent uterine sarcoma, doxorubicin produced an overall response rate (RR) of 19% and median survival of 11.6 months, which was similar to the response with combination chemotherapy (RR 19%, median survival 10.9 months). A randomized trial comparing ifosfamide plus cisplatin versus ifosfamide alone in mixed mesodermal tumors showed a significant improvement in RR and progression-free survival with the combination compared with ifosfamide alone, however, the combination was associated with increased toxicity including death. A randomized trial comparing doxorubicin to doxorubicin with dacarbazine in women with advanced or recurrent uterine sarcoma demonstrated a significantly higher RR with the combination (P < 0.05), but no significant difference in survival.


CONCLUSIONS
Offering palliative chemotherapy to patients with advanced, unresectable uterine sarcoma who are symptomatic from this disease is a reasonable decision. Doxorubicin is an option for women with advanced uterine sarcoma. The combination of cisplatinum and ifosfamide is also an option for women with metastatic mixed mesodermal tumors; however, this combination is associated with significant toxicity when compared to ifosfamide alone.
Kanjeekal
Sindu
S
University of Ottawa, Ottawa, Ontario, Canada. ccopgi@mcmaster.ca
Chambers
Alexandra
A
Fung
Michael Fung Kee
MF
Verma
Shailendra
S
D017322:Clinical Trials, Phase II as Topic; D005260:Female; D006801:Humans; D007890:Leiomyosarcoma / Q000188:drug therapy; D018199:Mixed Tumor, Mesodermal / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D018203:Sarcoma, Endometrial Stromal / Q000188:drug therapy*; D014594:Uterine Neoplasms / Q000188:drug therapy*