Clinical significance of radiotherapy in patients with primary uterine carcinosarcoma: a multicenter retrospective study (KROG 13-08)

Abstract

ObjectiveTo investigate the role of radiotherapy (RT) in patients who underwent hysterectomy for uterine carcinosarcoma (UCS).MethodsPatients with the International Federation of Gynecology and Obstetrics stage I–IVa UCS who were treated between 1990 and 2012 were identified retrospectively in a multi-institutional database. Of 235 identified patients, 97 (41.3%) received adjuvant RT. Twenty-two patients with a history of previous pelvic RT were analyzed separately. Survival outcomes were assessed using the Kaplan-Meier method and Cox proportional hazards model.ResultsPatients with a previous history of pelvic RT had poor survival outcomes, and 72.6% of these patients experienced locoregional recurrence; however, none received RT after a diagnosis of UCS. Univariate analyses revealed that pelvic lymphadenectomy (PLND) and para-aortic lymph node sampling were significant factors for locoregional recurrence-free survival (LRRFS) and disease-free survival (DFS). Among patients without previous pelvic RT, the percentage of locoregional failure was lower for those who received adjuvant RT than for those who did not (28.5% vs. 17.5%, p=0.107). Multivariate analysis revealed significant correlations between PLND and LRRFS, distant metastasis-free survival, and DFS. In subgroup analyses, RT significantly improved the 5-year LRRFS rate of patients who did not undergo PLND (52.7% vs. 18.7% for non-RT, p<0.001).ConclusionAdjuvant RT decreased the risk of locoregional recurrence after hysterectomy for UCS, particularly in patients without surgical nodal staging. Given the poorer locoregional outcomes of patients previously subjected to pelvic RT, meticulous re-administration of RT might improve locoregional control while leading to less toxicity in these patients.

Carcinosarcomas of the Uterus: Prognostic Factors and Impact of Adjuvant Treatment

“…Our findings of no association between receipt of adjuvant radiotherapy and disease specific or overall survival are consistent with a number of other relatively small retrospective studies 21 , 23 , 29 , 31 , 32 and two previous randomized trials 33 , 34 that showed reduced locoregional recurrence but no independent effect on survival. Conversely, in larger studies utilizing SEER data, Manzerova et al 35 and Li et al 24 have reported a statistically significant improvement in overall survival among those who received radiotherapy, with risk reductions in the order of 25%.…”

Ultrasonographic Findings of Uterine Carcinosarcoma

“…The average age was 58.6 ± 11.0 years (median, 59 years), which was in accordance with recent Chinese and Korean reports [3,12] but was different from that of several international reports [13,14] (average age was 65 years); this discrepancy may have been influenced by the race of the patients. The symptoms of UCS are postmenopausal vaginal bleeding and menstrual disorders, vaginal discharge caused by necrosis or infection of the lesions, and the presence of an abdominal mass.…”

Outcome of adjuvant radiotherapy after total hysterectomy in patients with uterine leiomyosarcoma or carcinosarcoma: a SEER-based study

“…Overall, the authors concluded that the use of adjuvant radiotherapy reduced the risk of locoregional failure at 5 years by 53% [12]. Cha et al [19] examined the use of radiotherapy in 235 patients with primary uterine carcinosarcoma, of which 41% received adjuvant radiotherapy. The locoregional failure rate was lower for patients who received adjuvant radiotherapy than for those who did not (17.5% vs. 28.5%, P = 0.107), and adjuvant radiotherapy was associated with longer locoregional recurrence-free survival in patients who did not undergo pelvic lymph node dissection (52.7% vs. 18.7%, P < 0.001) [19].…”

“…Cha et al [19] examined the use of radiotherapy in 235 patients with primary uterine carcinosarcoma, of which 41% received adjuvant radiotherapy. The locoregional failure rate was lower for patients who received adjuvant radiotherapy than for those who did not (17.5% vs. 28.5%, P = 0.107), and adjuvant radiotherapy was associated with longer locoregional recurrence-free survival in patients who did not undergo pelvic lymph node dissection (52.7% vs. 18.7%, P < 0.001) [19]. Moreover, a study of 141 stage I-III uterine sarcoma patients demonstrated that postoperative radiotherapy, composing both EBRT and brachytherapy, with a total dose higher than 50 Gy significantly reduced the local recurrence rate [20].…”