title: Impact of chemotherapy in uterine sarcoma (UtS): review of 13 clinical trials from the EORTC Soft Tissue and Bone Sarcoma Group (STBSG) involving advanced/metastatic UtS compared to other soft tissue sarcoma (STS) patients treated with first line chemotherapy.
abstract: OBJECTIVE
  UtS are a group of uncommon tumors representing 1% of malignant neoplasms of the female genital tract, and 7% of sarcomas. The objective of this study was to evaluate the factors associated with the clinical behavior UtS.
  
  
  METHODS
  Information on 269 patients with advanced or metastatic first line UtS treated by chemotherapy was available in a database containing information on 3270 patients with advanced soft tissue sarcomas (STS) entered in EORTC-STBSG clinical trials between 1977 and 2010. The chemotherapy was aggregated in 4 categories: anthracyclines alone, ifosfamide alone, the combination of doxorubicin and ifosfamide, and CYVADIC.
  
  
  RESULTS
  Among the 269 UtS pts, there were 231 deaths (median OS 10.4months, 95% CI: 9.1-11.9) and 257 progressions and/or deaths (median PFS 4.1months, 95% CI: 3.5-4.9). Multivariate analyses reported PS (p<0.001) only to be a statistically significant prognostic factor for OS in UtS; for PFS, LMS histology (p=0.025) is associated with a better outcome. There was no relationship between the 4 groups of chemotherapy regimens and impact on clinical outcomes. Histological subtype was significantly correlated with response to chemotherapy (RR: LMS 19% vs other 33%, p=0.026). Ifosfamide single agent yielded only 5% of RR.
  
  
  CONCLUSIONS
  Clearly, UtS are very aggressive neoplasms with poor outcome when treated with chemotherapy consisting of anthracyclines with or without ifosfamide or cyclophosphamide. New strategies are urgently needed.
authors.affiliation: Département de Cancérologie médicale, Centre, Léon Bérard, Lyon, France. Electronic address: isabelle.ray-coquard@lyon.unicancer.fr.
authors.forename: I
authors.initials: I
authors.lastname: Ray-Coquard
authors.affiliation: European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium.
authors.forename: E
authors.initials: E
authors.lastname: Rizzo
authors.affiliation: Département de Cancérologie médicale, Centre, Léon Bérard, Lyon, France.
authors.forename: J Y
authors.initials: JY
authors.lastname: Blay
authors.affiliation: Fondazione IRCCS Instituto Nazionale dei Tumori, Milan, Italy.
authors.forename: P
authors.initials: P
authors.lastname: Casali
authors.affiliation: Royal Marsden Hospital, Chelsea, London, UK.
authors.forename: I
authors.initials: I
authors.lastname: Judson
authors.affiliation: Herlev Hospital, Copenhagen University, Herlev, Denmark.
authors.forename: A Krarup
authors.initials: AK
authors.lastname: Hansen
authors.affiliation: Klinikum der Universitaet Muenchen, Campus Grosshadern, Muenchen, Germany.
authors.forename: L H
authors.initials: LH
authors.lastname: Lindner
authors.affiliation: Ospedale Regionale "Ca' Foncello", Treviso, Italy.
authors.forename: A P
authors.initials: AP
authors.lastname: Dei Tos
authors.affiliation: Leiden University Medical Centre, Leiden, the Netherlands.
authors.forename: H
authors.initials: H
authors.lastname: Gelderblom
authors.affiliation: European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium.
authors.forename: S
authors.initials: S
authors.lastname: Marreaud
authors.affiliation: European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium.
authors.forename: S
authors.initials: S
authors.lastname: Litière
authors.affiliation: Maria Sklodowska-Curie Memorial Cancer Centre, Warsaw, Poland.
authors.forename: P
authors.initials: P
authors.lastname: Rutkowski
authors.affiliation: Mannheim University Medical Center, Mannheim, Germany.
authors.forename: P
authors.initials: P
authors.lastname: Hohenberger
authors.affiliation: Fondazione IRCCS Instituto Nazionale dei Tumori, Milan, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Gronchi
authors.affiliation: The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, London, UK.
authors.forename: W T
authors.initials: WT
authors.lastname: van der Graaf
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007890:Leiomyosarcoma / Q000188:drug therapy / Q000473:pathology; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D012509:Sarcoma / Q000188:drug therapy* / Q000473:pathology; D015996:Survival Rate; D014594:Uterine Neoplasms / Q000188:drug therapy* / Q000473:pathology
keywords: Chemotherapy; Sarcoma; Treatment; Uterine