Donyou cover the scar in adjuvant RT for uterine leiomyosarcoma?

[Kroll2013]

dear colleagues,
I have a patient that underwent a transabdominal resection for uterine leiomyosarcoma.
She needs adjuvant radiation to the pelvis.
1- do you cover the abdominopelvic scar?
2- do you give more than 45-50.4 gy (it was negative margins, 17cm tumor, grade3, with LN dissection done)?

Ty

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[Palex80]

1. No, I do not.
2. No, dose is fine in my opinion.

However: Evidence for the role of adjuvant RT in this situation is scarce. A negative randomized trial exists from the EORTC.
Phase III randomised study to evaluate the role of adjuvant pelvic radiotherapy in the treatment of uterine sarcomas stages I and II: an European O... - PubMed - NCBI

 

[Ray D. Ayshun]

This is a big, high grade tumor, which, on principle, needs adj Rt. On the other hand, an amputation was performed, and these cancers rarely go to the nodes, right (which were negative anyway)? what's the area at risk? In my mind it's vaginal stump, then peritoneal cavity, then lungs, and only one of those is a reasonable target, and not with ebrt. I guess I wonder what to treat, whole pelvis field/nodes? Is that worthwhile?

 

[Palex80]

Like I said: the EORTC has performed a randomized trial for EBRT in uterine sarcoma. Only the carcinosarcoma group seemed to benefit from adjuvant RT.

 

[Ray D. Ayshun]

Like I said: the EORTC has performed a randomized trial for EBRT in uterine sarcoma. Only the carcinosarcoma group seemed to benefit from adjuvant RT.

True. My question was literal, though. For my own edification, what is the target here?

 

[seper]

1. Scar does not need to be specifically targeted.
2. I omit RT in young pts, since RT does not improve rates of metastases but worsens QOL

 

[evilbooyaa]

1. No need to cover scar, IMO.
2. Agree with questionable benefit to adjuvant RT, however, is supported for consideration of systemic therapy and/or EBRT per NCCN. Wouldn't personally chase more than the stump and tumor bed, and not really sure what to do about nodal coverage.

 

[Palex80]

Leiomyosarcoma rarely spreads to the lymphatics. Carcinosarcoma does. That's why I woulnd't treat lymphatics (if I was to treat anyhow).