Multimodality adjuvant therapy and survival outcomes in stage I–IV uterine carcinosarcoma

Abstract

<jats:sec><jats:title>Objectives</jats:title><jats:p>Uterine carcinosarcoma is a rare, aggressive form of uterine cancer with a high recurrence rate and poor survival at all stages. We sought to evaluate the outcomes of patients treated with chemotherapy versus a combination of chemotherapy and radiation (chemoradiation) to determine survival.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>A multicenter retrospective analysis of patients with stage I–IV carcinosarcoma was conducted from January 2000 to December 2017. Inclusion criteria were primary surgical management, defined as hysterectomy ± salpingo-oophorectomy, comprehensive surgical staging and/or tumor debulking, followed by adjuvant chemotherapy or chemoradiation. Differences in the frequencies of stage, cytoreduction status, treatment delays and sites of disease recurrence were identified using Pearson’s χ<jats:sup>2</jats:sup> test. Progression-free and overall survival rates were calculated using Kaplan-Meier estimates.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Final analysis included 148 patients; 40.5% (n=60) chemotherapy and 59.5% (n=88) chemoradiation. The mean age was 67 years (range 39–89). Stage distribution included 24.3% stage I, 12.2% stage II, 37.2% stage III, and 26.3% stage IV. There was no difference in the frequency of stage (p=0.81), cytoreduction status (p=0.61), treatment delays (p=0.57), or location of recurrence (p=0.97) between cohorts. The most frequent location of recurrence was the abdomen (50.0%). The median progression-free survival favored chemoradiation over chemotherapy (15 vs 11 months, respectively), as did the median overall survival (26 vs 20 months, respectively). Chemoradiation was associated with a statistically significant improvement in 2 year progression-free survival (22.5% vs 13.6%; p=0.006) and 2 year overall survival (50.0% vs 35.6%; p=0.018) compared with chemotherapy alone. On subanalysis of patients receiving chemoradiation, ‘sandwich sequencing’ (chemotherapy–radiation–chemotherapy) was associated with superior overall survival compared with alternate therapy sequences (chemotherapy–radiation and radiation–chemotherapy) (34 months vs 14 months and 14 months, respectively) (p=0.038).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Chemoradiation was associated with improvement in both progression-free and overall survival for all stages of carcinosarcoma compared with chemotherapy alone.</jats:p></jats:sec>

Evaluation of Survival, Recurrence Patterns and Adjuvant Therapy in Surgically Staged High-Grade Endometrial Cancer with Retroperitoneal Metastases

“…We observed an increase in retroperitoneal recurrence in patients receiving adjuvant chemotherapy alone versus chemoradiation. These findings agree with existing retrospective as well as prospective data, suggesting the importance of radiation therapy in retroperitoneal disease control [13,[20][21][22]. Additionally, we observed a higher incidence of isolated positive para-aortic lymph nodes (18.1%) than previously reported in the literature.…”

Comparing paclitaxel-platinum with ifosfamide-platinum as the front-line chemotherapy for patients with advanced-stage uterine carcinosarcoma

“…49 Finally, the authors found that the "sandwich as chemotherapy-radiotherapy-chemotherapy" schedule provided a best benefit to patients with UCS because this "sandwich" therapy was associated with longer OS than sequential chemotherapyradiotherapy and radiotherapy-chemotherapy protocols (34 vs 14 months, p = 0.038). 49 In the current study, our results failed to show the positive impact on prognosis with adding radiotherapy, although many studies, including a recent Taiwan's largest study, favored its additional or synergistic positive effect on survival of UCS. [47][48][49][50] To further dissect the potential reason, we analyzed a total of six patients (five in PP and one in IP) who had been treated with radiotherapy as adjuvant therapy.…”

“…During a median follow-up of 60 months, the authors found the best outcomes (PFS = 35 months, 95 % CI, 0.26-0.43; OS = 47 months, 95 % CI, 0.38-0.56) in women treated with IP. 49 However, recent evidence supports that UCS is various forms of poorly differentiated uterine carcinomas, 1,2,13,17,[29][30][31][32] contributing to the reconsideration of the use of paclitaxel in place of ifosfamide for UCS. 35,36 Powell et al 35 conducted a single-arm phase II GOG-232B trial to evaluate the efficacy of PP for recurrent or metastatic UCS to obtain 13% and 41%, of compete and partial response rates, respectively, in 55 advanced UCS (stage III and IV) patients.…”

Effect of adjuvant therapy on the prognosis in stage I/II uterine carcinosarcoma: A meta‐analysis

“…Besides, like endometrial adenocarcinoma, the uterine carcinosarcoma risk is decreased by the history of oral contraceptive pill use 6 . However, uterine carcinosarcoma presents with extra‐uterine disease in 60% of cases, while most of the endometrial ademocarcinoma is of early stage and low grade 7–9 . The 5‐year survival of uterine carcinosarcoma is estimated to be less than 40%, and more than half will recur although primary surgery and adjuvant therapy 8,10 .…”

“…However, uterine carcinosarcoma presents with extra‐uterine disease in 60% of cases, while most of the endometrial ademocarcinoma is of early stage and low grade 7–9 . The 5‐year survival of uterine carcinosarcoma is estimated to be less than 40%, and more than half will recur although primary surgery and adjuvant therapy 8,10 . Tumor stage was identified to be the most important prognostic factor for uterine carcinosarcoma 11 …”