Toxicity of chemotherapeutical protocols in the treatment of uterine sarcomas (Vincristine, actinomycin D, Cyclophosphamide VAC versus ifosfamide).

Objective: Uterine sarcomas are rare tumors which account for 1% of all genital tract malignancies. They have a poor prognosis with an overall survival of under 50% at 2 years. The benefit of chemotherapy is unclear and different chemotherapy protocols are used for the treatment of uterine sarcomas. But there is little experience about their toxicity because of the limited case series. So we compared VAC protocol and ifosfamiide for toxic effects.

Material And Method: We reviewed 13 cases which were diagnosed as uterine sarcomas and treated with surgery plus chemotherapy at The Department of Obstetrics and Gynecology, Akdeniz University School of Medicine from 1990 to 1995. Data were obtained from patient files.

Results: Mean age was 55.7 (range 38-70), 7 (53.8%) patients had malignant mixed mullerian tumors and 6 (46.1) had leiomyosarcomas. A total of 32 courses of chemotherapy were given -20 ifosfamide and 12 VAC therapy. Leucopenia, hepatic dysfunction and peripheral neuropathy were more frequent in the VAC group as 75%, 16.6%, versus 30%, 0%, 0%, in the iFosfamide group respectively. However, urothelial toxicity (35%) was more common in the ifosfamide group.

Conclusion: VAC protocol is more toxic for the liver, hematopoietic and peripheral neurologic system. On the other hand the major toxicity of ifosfamide was on the urinary tract. Ifosfamide may be a good choice with less toxicity than VAC therapy in the treatment of uterine sarcomas.