Metastatic uterine sarcoma: A systematic review of the literature
Bibliographic record
Abstract
5105 Background: Uterine sarcomas are rare and management of metastatic disease often conforms to treatment practice for other metastatic soft tissue sarcomas. We have conducted a systematic review of systemic chemotherapy in the management of metastatic uterine sarcoma. Methods: MEDLINE and the Cochrane Library databases, as well as the proceedings from ASCO, were searched for articles that were (1) systematic reviews, practice guidelines, meta-analysis, or randomized controlled trials (RCT) comparing treatment regimens for metastatic uterine sarcoma or (2) prospective phase II trials or retrospective reviews reporting the effects of treatment for > 20 patients. Efficacy (response rate, progression free and overall survival) and toxicity were evaluated. Results: Three RCTs and 21 prospective phase II trials were identified that met the search criteria. The overall response rate (RR) for single agent doxorubicin (D) was 19% for all sub-types of metastatic uterine sarcomas. D combined with either dimethyl triazenoimidazole carboxamide (DTIC) or cyclophosphamide compared to D alone showed no survival benefit and there was increased toxicity with combination treatment. The two most active single agents for first-line treatment of mixed mesodermal tumours (MMT) were ifosfamide (I) (RR=39% and cisplatinum (C) (RR=19%). In an RCT of first-line treatment of MMT, the combination of I and C compared to I alone, resulted in a higher RR (57% versus 39%) and a small improvement in progression-free survival (6.0 vs 4.0 months, p=0.02). However, there was also greater toxicity and no significant improvement in overall survival. A small phase II study of second-line therapy in patients with leiomyosarcoma (LMS) treated with the combination of gemcitabine and docetaxel reported a RR of 53% and a relatively mild toxicity profile. Pooled efficacy and toxicity data will be presented. Conclusions: There is a paucity of high quality RCTs that examine the role of systemic therapy in patients with metastatic uterine sarcoma. Patients and practitioners should be encouraged to take part in such trials. No significant financial relationships to disclose.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.025 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.009 | 0.007 |
| Bibliometrics | 0.015 | 0.016 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.006 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".