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Efficacy of adjuvant CYVADIC chemotherapy in early-stage uterine sarcomas: results of long-term follow-up
  1. K. Odunsi*,
  2. V. Moneke,
  3. J. Tammela*,
  4. S. Ghamande,
  5. P. Seago*,
  6. D. Driscoll§,
  7. D. Marchetti*,
  8. T. Baker* and
  9. S. Lele*
  1. * Department of Gynecological Oncology, State University of New York at Buffalo, Buffalo, NY
  2. Department of Obstetrics and Gynecology, State University of New York at Buffalo, Buffalo, NY
  3. Department of Obstetrics and Gynecology, Medical College of Georgia, Augusta, GA
  4. § Department of Surgical Oncology, Roswell Park Cancer Institute, Buffalo, NY
  1. Address correspondence and reprint requests to: Shashikant Lele, MD, Department of Gynecological Oncology, Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY 14263. Email: shashi.lele{at}


Data on adjuvant chemotherapy in early-stage uterine sarcomas are conflicting and most often 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.

  • chemotherapy
  • survival
  • uterine sarcoma

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