Efficacy of adjuvant CYVADIC chemotherapy in early-stage uterine sarcomas: Results of long-term follow-up

K. Odunsi, V. Moneke, J. Tammela, Sharad A Ghamande, P. Seago, D. Driscoll, D. Marchetti, T. Baker, Sashikant Lele

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26 Scopus citations

Abstract

Data on adjuvant chemotherapy in early-stage uterine sarcomas are conflicting and most of ten based on small patient groups with relatively short duration of follow-up. Approximately 60% of patients present with stage I disease with an overall 5-year survival of 30-50% when treated with surgery alone. This study examines the efficacy and results of long-term follow-up of a multiagent chemotherapy regimen of cyclophosphamide, vincristine, doxorubicin, and dacarbazine (CYVADIC) as adjuvant treatment for patients with stage I uterine sarcoma. Between 1982 and 1999, 24 evaluable patients with completely staged uterine sarcomas received adjuvant multiagent chemotherapy with vincristine sulfate (1mg/m2) on days 1 and 4, doxorubicin (40 mg/m2) and cyclophosphamide (400 mg/m2) on day 2, and dacarbazine (200 mg/m2) on days 1 through 4 for a total of nine monthly cycles or until recurrence of disease was documented. Survival distributions were calculated by the Kaplan-Meier method, and statistical significance was determined with the log-rank test. Factors significant on univariate analysis were analyzed in a multivariate fashion using Cox proportional hazards model. The histologic distribution of patients was 46% leiomyosarcoma, 33% mixed mullerian tumors, 13% stromal sarcomas, 4% adenosarcomas, and 4% hemangiosarcoma. The patients received 206 of a planned 216 cycles of chemotherapy. The median follow-up of the patient population was 93 months (range 11-213 months). Eight patients (33%) developed recurrent disease. The median time to recurrence was 19 months (range 7-184 months). The estimated survival for the entire group was 88, 75, and 69% at 2, 5, and 15 years, respectively. Factors that did not affect survival included age, histology, and tumor grade. Four patients required dose reductions secondary to grade 2-3 toxicities (hematologic). Grade 1 neurotoxicity was observed in six patients (25%) and grade 2 neurotoxicity in one patient (4%). Adjuvant CYVADIC chemotherapy appears to be safe and well tolerated in patients with stage I uterine sarcomas. Our data provide information on the longest duration of follow-up ever reported and suggests that CYVADIC may have a potential role in the adjuvant treatment of early-stage uterine sarcoma.

Original languageEnglish (US)
Pages (from-to)659-664
Number of pages6
JournalInternational Journal of Gynecological Cancer
Volume14
Issue number4
DOIs
StatePublished - Jul 1 2004

Keywords

  • CYVADIC
  • Chemotherapy
  • Survival
  • Uterine sarcoma

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Oncology
  • Cancer Research

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