ABSTRACT
During the period from January 1985 to June 1999, 75 patients with uterine sarcoma were accrued in the National Cancer Institute, Cairo University. Surgery was the initial therapy for all patients. Of the 75 patients, 34 received postoperative irradiation and/or chemotherapy. Twenty-two [32%] survived 2 years, while 3 patients [4.3%] survived 5 years. The overall recurrence rate was similar in patients who received adjuvant treatment [94%] and in those who did not [97%]. There was no difference in local pelvic recurrence between patients who received adjuvant therapy and those who did not [2 1.4% Vs. 25%]; however the median time to pelvic recurrence was longer, 11 months [range 2-21 months] for the irradiated group versus 6 months [range 2-11 months] for the non irradiated group. There was neither a difference in the incidence of distant relapse [38.2% vs. 34.4%], nor a difference in the median time to relapse, 7 months for both [range 2-17] be-tween patients who received adjuvant therapy and those who did not. Local and distant relapses were observed in 27% of patients who received adjuvant therapy versus 32% in the no adjuvant therapy group, with a median time to relapse of 3 months [1-10 months] for both groups. Most of the failures occurred in the pelvis, followed by lung and abdomen. Relapsing patients did not benefit of either local radiotherapy or chemotherapy. In conclusion, uterine sarcomas have an aggressive clinical behavior, with a propensity to recur both locally and at remote sites. Surgery in the form of total abdominal hysterectomy [TAH] plus bilateral salpingio-oophorectomy remains the treatment of choice. The role of pelvic lymphadenectomy and aortic lymph node sampling may be beneficial especially in early stage disease, although its role in improving survival has not yet been demonstrated. There is no definite evidence that adjuvant pelvic irradiation or systemic chemotherapy improves survival. The policy of adjuvant therapy following surgery for uterine sarcoma needs further evaluation