Uterine sarcomas: a review of the Edinburgh experience from 1974 to 1992

A retrospective review of patients treated for a uterine sarcoma in Edinburgh from 1974 to 1992 has been performed. Clinical details at presentation, tumour pathology, treatment and the outcome of treatment were all recorded. 82 patients' case notes were reviewed. 54 patients had died and 28 were alive (mean follow-up period 80.3 months). 39 patients had a malignant mixed mesodermal tumour, 12 patients had an endometrial stromal sarcoma, and 27 had a leiomyosarcoma. Using a modified FIGO staging retrospectively, 41 patients had Stage 1 disease, two patients had Stage 2, 16 patients had Stage 3, and 13 patients had Stage 4 disease. Definitive treatment of total abdominal hysterectomy and bilateral salpingo-oophorectomy was used in 69 patients, with 35 of these patients also receiving post-operative radiotherapy to the pelvis. 13 patients did not undergo surgery. Five of these patients received radical radiotherapy, three patients received palliative radiotherapy, and five patients were not treated. The overall median survival is 15 months and the 5-year actuarial survival is 31%. 25 of the 26 surviving patients had Stage 1 disease at presentation. Post-operative pelvic radiotherapy did not influence either survival or local tumour control. 51 of the 54 patients who relapsed had evidence of distant metastases. We conclude that total abdominal hysterectomy and bilateral salpingo-oophorectomy remains the treatment of choice for uterine sarcomas.