Optimal Debulking Surgery Followed by Paclitaxel/Platinum Chemotherapy Is Very Effective in Treating Ovarian Carcinosarcomas: A Single Center Experience

Abstract

Background: There have been only a few reports on the survival and management of patients with ovarian carcinosarcomas. We evaluated the clinical characteristics, outcomes and prognostic factors of ovarian carcinosarcomas. Methods: Retrospective analysis of data obtained from medical records of 40 patients treated at the Asan Medical Center, Seoul, Korea, between January 1989 and January 2008. Results: Median survival was significantly longer in patients <60 years of age than in those ≧60 (p = 0.001), patients with early-stage compared to advanced tumors (p = 0.035), those with optimally debulked tumors compared to suboptimally (p < 0.001) in the advanced stage, and patients treated with paclitaxel/platinum compared to patients treated with other chemotherapies (p < 0.001). The progression-free interval was longer in patients with early-stage (p = 0.003) and optimally debulked tumors (p = 0.001), as well as in those treated with paclitaxel/platinum (p = 0.049). Multivariate analysis showed that advanced-stage, non-optimal debulking and non-paclitaxel/platinum chemotherapy were significant independent predictors of a shorter progression-free interval, and that non-optimal debulking and non-paclitaxel/platinum chemotherapy were significant independent predictors of shorter overall survival. Conclusions: Early-stage optimal debulking and adequate chemotherapy can influence time to progression and survival, indicating that the most effective treatment for patients with ovarian carcinosarcomas consists of optimal debulking surgery followed by paclitaxel/platinum chemotherapy.

Ovarian Carcinosarcoma: Effects of Cytoreductive Status and Platinum-Based Chemotherapy on Survival

“…Our findings corroborate other reports that have demonstrated that ovarian carcinosarcoma is an extremely aggressive subtype of epithelial ovarian cancer that is often advanced at diagnosis [2–4, 10], and that age and stage are associated with overall survival [2, 5, 9, 11, 12]. Furthermore, we showed that extent of primary cytoreductive surgery and residual disease status correlate with outcome, consistent with previous reports.…”

“…Most published data are limited to retrospective reviews, and because of the rarity of the disease, few institutions are able to accrue a sufficient number of patients for prospective studies. Some studies suggest that an optimal surgical cytoreductive effort at the time of primary surgery and adjuvant chemotherapy may be associated with improved overall survival [2, 7–9]. Our assumptions regarding the best surgical treatments and adjuvant therapies for this disease are extrapolated from studies of patients with epithelial ovarian carcinoma or uterine carcinosarcoma.…”

Ovarian Cancer, Version 1.2016, NCCN Clinical Practice Guidelines in Oncology

“…219 Optimal surgical debulking is recommended for patients with MMMTs (see "Principles of Surgery" in the complete version of these guidelines [OV-A]). 219,[222][223][224] After complete surgical staging, several postoperative chemotherapy regimens are recommended for patients with stage I to IV MMMT. Patients with stage I to IV MMMT may be treated as per epithelial ovarian cancer (see OV-3; page 1138).…”

Response to pembrolizumab in a heavily treated patient with metastatic ovarian carcinosarcoma

“…According to an analysis of the Surveillance, Epidemiology and End Results data, the rate of OCS is 0.19 per 100,000 women [3]. Despite the rarity of OCS, it is associated with a high rate of cancer-related mortality even at early stages [4]. OCS typically occurs in postmenopausal women at a median age of 65 years and is staged according to FIGO criteria for epithelial ovarian cancer (EOC) [5].…”

“…OCS typically occurs in postmenopausal women at a median age of 65 years and is staged according to FIGO criteria for epithelial ovarian cancer (EOC) [5]. More than 70% of patients present with advanced stage (stage III-IV) disease at the time of diagnosis [4]. The most common symptoms resemble those observed with EOC, including pelvic and/or abdominal pain, early satiety, bloating, and abdominal distention [6].…”