The Prognostic Benefit of Early Postoperative Radiotherapy and Diagnostic Value of Serologic Markers on Women with Uterine Sarcoma and Carcinosarcoma

Abstract

Introduction : Women with uterine sarcoma represent a rare heterogenous group with unproven evidence regarding the optimal adjuvant treatment. We aimed to evaluate outcomes and the impact of postoperative radiotherapy (RT). Methods : We retrospectively identified 51 patients, treated with curative adjuvant pelvic radio(chemo)therapy for carcinosarcoma (n=30), leiomyosarcoma (n=14) and endometrial stromal sarcoma (n=7) between 2001-2021. Blood counts and serologic markers were documented prior to surgery, pre- and post-RT. Results : With a median follow-up of 34.7 months, overall survival (OS) 1-, 2- and 5-year rates were 89.9%, 73.3% and 51.7%, respectively, and significantly inferior with positive nodal and resection status, cervical and parametrial infiltration, with higher age and FIGO-stage. A shorter time interval from surgery to RT and normal preoperative leukocyte counts were identified as significantly favorable. Distant control (DC) rates were 84.0% and 60.7% and local control (LC) were 93.7% and 88.2% for 1 and 5 years, respectively, and significantly inferior with a higher FIGO stages, positive resection margins and serosal involvement. DC was poor for cervical infiltration, positive nodal status and with higher Glasgow-Prognostic-Scores. Treatment caused strong declines in leukocyte and hemoglobin levels; however, only moderate toxicity was observed (CTCAE grade <4). Conclusion : RT shortly (≤8 weeks) after hysterectomy was well tolerated achieving efficient LC, but with a significant decrease in blood counts. This study confirms the poor OS of uterine sarcoma due to high failures in DC and shows evidence for the correlation of preoperative leukocyte count and pre-RT Glasgow-Prognostic-Score for prognosis.