Clinical analysis of postoperative sequential chemoradiotherapy in patients with stage I low-grade endome-trial stromal sarcoma

CHEN Jiao; KONG Weimin; ZHANG Tongqing; SONG Dan; JIAO Simeng; LI Xia; LIU Yao; SHANG Ruotian

Abstract：Objective To investigate the effect of sequential chemoradiotherapy after surgery on survival of patients with stage I low-grade endometrial stromal sarcoma( LGESS) , and evaluate side effects. Methods A total of 52 patients were collected from June 1995 to December 2010. Twenty-eight patients received sequential chemoradiotherapy following surgery, and 24 patients received sur-gery alone as control. Patients in sequential chemoradiotherapy group received 2 cycles of chemotherapy( CYVADIC, VAD or IAP regi-men) , and then pelvic external radiation was applied with DT of 40-50 Gy. Two cycles of chemotherapy was followed by radiation. The survival and recurrence were evaluated, as well as side effects. Results The median follow-up was 118 months(20-185 months)with the follow-up rate of 92. 3%. In 52 patients, 9 cases developed recurrence, with 7 cases relapsed in control group. The 5-,10-year re-currence-free survival rates were 96. 4% and 91. 4% in sequential chemoradiotherapy after surgery group, higher than 75. 0% and 70. 3% in control group(P=0. 035);the 5-,10-year overall survival rates had no statistical difference between the two groups(P>0. 05) . All 28 patients with sequential chemoradiotherapy completed treatment. The chemotherapy-related toxic effects were mainly gas-trointestinal reactions and hematologic toxicities, and the gastrointestinal reactions were all grade 1 or 2. Thirteen patients experienced hematologic toxicities and grade 3 or 4 hematologic toxicities were observed in 5 patients, which could recovered after expectant treat-ment. The radiation reaction was mainly radiation proctitis and vaginitis of grade 1 or 2. No acute grade 3 or 4 radiation toxicities were observed. There was no treatment-related death. Conclusion LGESS has good prognosis, but it is with a tendency to develop late re-currence, even for stage Ⅰ patients. The main treatment is surgery. Sequential chemoradiotherapy after surgery is suggested to reduce the pelvic recurrence, and the toxic effects can be well tolerated.