Combined adjuvant cisplatin and ifosfamide chemotherapy and radiotherapy for malignant mixed mullerian tumors of the uterus

Wong, LC; See, H. T.; Khoo-Tan, H. S.; Low, Jeffrey; Ng, Wai-Hoe

doi:10.1111/j.1525-1438.2006.00560.x

Cited by 19 publications

(5 citation statements)

References 38 publications

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“…The authors reported that sequential treatment after surgery decreased mortality, as compared to patients taking RT or CT alone [ 13 ]. Similarly, Wong et al [ 14 ], who reported a protocol of cisplatin and ifosfamide-based CT along with RT in 43 patients, noted improved survival in patients who received both CT and RT. However, these two studies did not provide separate analysis for early or advanced stages of disease.…”

Section: Discussionmentioning

confidence: 87%

Adjuvant Treatment Modalities, Prognostic Predictors and Outcomes of Uterine Carcinosarcomas

et al. 2014

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PurposeThe purpose of this study is to evaluate the clinicopathological characteristics, treatment, and prognosis of uterine carcinosarcoma (UC).Materials and MethodsA retrospective review of three cancer registry databases in Turkey was conducted for identification of patients diagnosed with UC between January 1, 1996, and December 31, 2012. We collected clinicopathological data in order to evaluate factors important in disease- free survival (DFS) and overall survival (OS).ResultsA total of 66 patients with UC with a median age of 65.0 years were included in the analysis. The median survival time of all patients was 37.5 months and the 5-year OS rate was 59.1%. In early stage patients (I-II) who received adjuvant chemotherapy (CT) with radiation therapy (RT), the median DFS and OS was 44 months and 55 months, respectively, compared to 34.5 months and 36 months, respectively, in patients who received adjuvant RT or CT alone (hazard ratio [HR], 1.4; 95% confidence interval [CI], 0.7 to 3.1 for DFS; p=0.23 and HR, 2.2; 95% CI, 0.9 to 5.3 for OS; p=0.03). In advanced stage patients (III-IV), the median DFS and OS of patients receiving adjuvant RT with CT was 25 months and 38 months, respectively, compared to 23.5 months and 24.5 months, respectively, in patients receiving adjuvant RT or CT alone (HR, 3.1; 95% CI, 0.6 to 16.0 for DFS; p=0.03); (HR, 3.3; 95% CI, 0.7 to 15.0 for OS; p=0.01). In multivariate analysis, advanced International Federation of Gynecology and Obstetrics (FIGO) stage and suboptimal surgery showed significant association with poor OS.ConclusionIn patients with early or advanced stage UC, adjuvant CT with RT is associated with improved DFS and OS, as compared to CT or RT alone.

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Section: Discussionmentioning

confidence: 87%

Adjuvant Treatment Modalities, Prognostic Predictors and Outcomes of Uterine Carcinosarcomas

et al. 2014

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“…In this context, there have been several studies which have investigated the role of adjuvant therapy in uterine carcinosarcoma using multimodal approach since year 2000 [18-20]. These studies all show that treatment, which includes surgical operation, radiation therapy, and chemotherapy, increased the OS of uterine carcinosarcoma patients compared to treatment that only involves PORT or chemotherapy alone.…”

Section: Discussionmentioning

confidence: 99%

The influence of adjuvant radiotherapy on patterns of failure and survivals in uterine carcinosarcoma

Park

Kim

et al. 2011

Radiat Oncol J

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PurposeTo evaluate the impact of postoperative radiotherapy (PORT) on patterns of failure and survivals in uterine carcinosarcoma patients treated with radical surgery.Materials and MethodsBetween October 1998 and August 2010, 19 patients with stage I-III uterine carcinosarcoma received curative hysterectomy and bilateral salpingo-oophorectomy with or without PORT at Seoul National University Hospital. Their hospital medical records were retrospectively reviewed. PORT and non-PORT groups included 11 and 8 patients, respectively. They were followed for a mean of 22.7 months (range, 7.8 to 126.6 months).ResultsAt 5 years, the overall survival rates were 51.9% for entire, 61.4% for PORT, and 41.7% for non-PORT groups, respectively. There was no statistical difference between PORT and non-PORT groups with regard to overall survival (p = 0.682). Seven out of 19 (36.8%) patients showed treatment failures, which all happened within 12 months. Although the predominant failures were distant metastasis in PORT group and loco-regional recurrence in non-PORT group, there was no statistically significant difference in loco-regional recurrence-free survival (LRRFS) (p = 0.362) or distant metastasis-free survival (DMFS) (p = 0.548). Lymph node metastasis was found to be a significant prognostic factor in predicting poor LRRFS (p = 0.013) and DMFS (p = 0.021), while the International Federation Gynecology and Obstetrics (FIGO) stage (p = 0.043) was associated with LRRFS.ConclusionConsidering that adjuvant radiotherapy after surgical resection was effective to decrease loco-regional recurrence and most treatment failures were distant metastasis, multimodal therapy including surgery, radiotherapy, and chemotherapy might be an optimal treatment for uterine carcinosarcoma patients.

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“…Currently, there is no consensus treatment guidelines related to improved survival outcomes. The rarity of this tumor limits the potential for large clinical trials [ 73 ]. Nevertheless, the persistent high mortality rate and high recurrence rate [ 73 ] with no significant improvement in patient survival during the past 40 years [ 24 ] demands the attention and time of researchers in a fight to improve treatment modalities and widen the understanding of uterine MMMT.…”

Section: Discussionmentioning

confidence: 99%

Malignant mixed Mullerian tumors of the uterus: histopathological evaluation of cell cycle and apoptotic regulatory proteins

2010

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AimThe aim of our study was to evaluate survival outcomes in malignant mixed Mullerian tumors (MMMT) of the uterus with respect to the role of cell cycle and apoptotic regulatory proteins in the carcinomatous and sarcomatous components.Methods23 cases of uterine MMMT identified from the Saskatchewan Cancer Agency (1970-1999) were evaluated. Immunohistochemical expression of Bad, Mcl-1, bcl-x, bak, mdm2, bax, p16, p21, p53, p27, EMA, Bcl-2, Ki67 and PCNA was correlated with clinico-pathological data including survival outcomes.ResultsHistopathological examination confirmed malignant epithelial component with homologous (12 cases) and heterologous (11 cases) sarcomatous elements. P53 was strongly expressed (70-95%) in 15 cases and negative in 5 cases. The average survival in the p53+ve cases was 3.56 years as opposed to 8.94 years in p53-ve cases. Overexpression of p16 and Mcl-1 were observed in patients with longer survival outcomes (> 2 years). P16 and p21 were overexpressed in the carcinomatous and sarcomatous elements respectively. Cyclin-D1 was focally expressed only in the carcinomatous elements.ConclusionsOur study supports that a) cell cycle and apoptotic regulatory protein dysregulation is an important pathway for tumorigenesis and b) p53 is an important immunoprognostic marker in MMMT of the uterus.

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Combined adjuvant cisplatin and ifosfamide chemotherapy and radiotherapy for malignant mixed mullerian tumors of the uterus

Cited by 19 publications

References 38 publications

Adjuvant Treatment Modalities, Prognostic Predictors and Outcomes of Uterine Carcinosarcomas

Adjuvant Treatment Modalities, Prognostic Predictors and Outcomes of Uterine Carcinosarcomas

The influence of adjuvant radiotherapy on patterns of failure and survivals in uterine carcinosarcoma

Malignant mixed Mullerian tumors of the uterus: histopathological evaluation of cell cycle and apoptotic regulatory proteins

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