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Trends in the Treatment of Uterine Leiomyosarcoma in the Medicare Population
  1. Olivia W. Foley, BA,
  2. J. Alejandro Rauh-Hain, MD,
  3. Joel Clemmer, BA,
  4. Rachel M. Clark, MD,
  5. Tracilyn Hall, MD,
  6. Elisabeth J. Diver, MD,
  7. John O. Schorge, MD and
  8. Marcela G. del Carmen, MD, MPH
  1. Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
  1. Address correspondence and reprint requests to Marcela G. del Carmen, MD, MPH, Division of Gynecologic Oncology, Vincent Obstetrics and Gynecology, Massachusetts General Hospital, 55 Fruit St, Yawkey 9E, Boston, MA 02114. E-mail: mdelcarmen@partners.org.

Abstract

Objective Uterine leiomyosarcoma (LMS) is a relatively rare malignancy that is associated with a poor prognosis. The rarity of LMS has led to a lack of consensus regarding appropriate treatment. The goal of this study was to identify the role that chemotherapy and radiotherapy have played in the treatment of uterine LMS in the United States as well as the effectiveness of adjuvant treatment.

Materials/Methods We used the SEER (Surveillance, Epidemiology, and End Results)-Medicare database to gather information on uterine LMS patients older than the age of 66 years diagnosed between 1992 and 2009. Basic demographic and clinical characteristics were collected. A logistic regression model analysis was performed to determine predictors of treatment. Cox proportional hazards models were used to identify clinical parameters and treatment strategies associated with survival differences.

Results Our final study group included 230 patients. We found that the rate of use of chemotherapy and radiotherapy in the treatment of patients with uterine LMS increased over the period investigated. However, we identified no significant survival advantage associated with either mode of therapy. The strongest predictor of survival was stage at diagnosis. The logistic regression model analysis revealed that age at diagnosis, treatment year, stage, and underlying health status were all independent predictors of chemotherapy. Age at diagnosis was also a predictor of radiation therapy.

Conclusions The increasing rates of chemotherapy and radiotherapy use in this population seem to be unfounded given the lack of survival benefit. Further investigation into alternative treatment regimens is merited. The prognostic significance of stage at diagnosis indicates the importance of improving early detection of uterine LMS.

  • Uterine leiomyosarcoma
  • Chemotherapy
  • Radiotherapy
  • Survival

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Footnotes

  • Supported by the Deborah Kelly Center for Outcomes Research, Massachusetts General Hospital.

  • The authors declare no conflicts of interest.

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