Malignant uterine smooth muscle tumors: Role of etoposide, cisplatin, and doxorubicin (EPA) chemotherapy

Background: Nearly 80% of patients with malignant uterine smooth muscle tumor will suffer local relapse and/or distant metastases after initial surgical resection. There is no convincing evidence that the addition of pelvic radiation improves the outcome. However, adjuvant chemotherapy might be an appropriate therapeutic modality. Methods: Between 1986 and 1991, 13 consecutive patients with malignant uterine smooth muscle tumors were treated at Yale-New Haven Hospital with a combination chemotherapy containing etoposide 100 mg/M² on days 1 and 2, cisplatin 50 mg/M² on day 1, and doxorubicin 50 mg/M² on day 1, repeated every 28 days. Six patients had Stage I disease, one patient had Stage III disease, and six patients had Stage IV disease. The number of cycles ranged from 2 to 9. Results: The median follow-up was 30 months (range 4-81). The mean overall survival for the group was 43.1 ± 6.7 months, with the progression-free interval of 25.5 ± 8.0 months. Of the seven patients with evaluable disease, one patient had complete response and one had partial response (total response rate of 28.6%). Of the six patients treated adjuvantly, three recurred at 9, 33, and 59 months (recurrence rate of 50%). Conclusions: We conclude that this combination has only modest activity against malignant uterine smooth muscle tumors at the schedule and doses tested.