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

Research output: Contribution to journalArticle

26 Citations (Scopus)

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

Fingerprint

Adjuvant Chemotherapy
Sarcoma
Dacarbazine
Survival
Vincristine
Doxorubicin
Cyclophosphamide
CYVADIC protocol
Mullerian Mixed Tumor
Adenosarcoma
Recurrence
Drug Therapy
Hemangiosarcoma
Leiomyosarcoma
Proportional Hazards Models
Histology

Keywords

  • CYVADIC
  • Chemotherapy
  • Survival
  • Uterine sarcoma

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Oncology
  • Cancer Research

Cite this

Efficacy of adjuvant CYVADIC chemotherapy in early-stage uterine sarcomas : Results of long-term follow-up. / Odunsi, K.; Moneke, V.; Tammela, J.; Ghamande, Sharad A; Seago, P.; Driscoll, D.; Marchetti, D.; Baker, T.; Lele, Sashikant.

In: International Journal of Gynecological Cancer, Vol. 14, No. 4, 01.07.2004, p. 659-664.

Research output: Contribution to journalArticle

Odunsi, K. ; Moneke, V. ; Tammela, J. ; Ghamande, Sharad A ; Seago, P. ; Driscoll, D. ; Marchetti, D. ; Baker, T. ; Lele, Sashikant. / Efficacy of adjuvant CYVADIC chemotherapy in early-stage uterine sarcomas : Results of long-term follow-up. In: International Journal of Gynecological Cancer. 2004 ; Vol. 14, No. 4. pp. 659-664.
@article{4d4cb327db594a64af18f25e43d42314,
title = "Efficacy of adjuvant CYVADIC chemotherapy in early-stage uterine sarcomas: Results of long-term follow-up",
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.",
keywords = "CYVADIC, Chemotherapy, Survival, Uterine sarcoma",
author = "K. Odunsi and V. Moneke and J. Tammela and Ghamande, {Sharad A} and P. Seago and D. Driscoll and D. Marchetti and T. Baker and Sashikant Lele",
year = "2004",
month = "7",
day = "1",
doi = "10.1111/j.1048-891X.2004.14420.x",
language = "English (US)",
volume = "14",
pages = "659--664",
journal = "International Journal of Gynecological Cancer",
issn = "1048-891X",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Efficacy of adjuvant CYVADIC chemotherapy in early-stage uterine sarcomas

T2 - Results of long-term follow-up

AU - Odunsi, K.

AU - Moneke, V.

AU - Tammela, J.

AU - Ghamande, Sharad A

AU - Seago, P.

AU - Driscoll, D.

AU - Marchetti, D.

AU - Baker, T.

AU - Lele, Sashikant

PY - 2004/7/1

Y1 - 2004/7/1

N2 - 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.

AB - 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.

KW - CYVADIC

KW - Chemotherapy

KW - Survival

KW - Uterine sarcoma

UR - http://www.scopus.com/inward/record.url?scp=4043065772&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=4043065772&partnerID=8YFLogxK

U2 - 10.1111/j.1048-891X.2004.14420.x

DO - 10.1111/j.1048-891X.2004.14420.x

M3 - Article

VL - 14

SP - 659

EP - 664

JO - International Journal of Gynecological Cancer

JF - International Journal of Gynecological Cancer

SN - 1048-891X

IS - 4

ER -