Outcome and Predictive Factors in Uterine Carcinosarcoma Using Postoperative Radiotherapy: A Rare Cancer Network Study

Abstract

Uterine carcinosarcomas (UCS) are rare tumors. Consensus regarding therapeutic management in non-metastatic disease is lacking. This study reports on outcome and predictive factors when using postoperative radiotherapy. We analyzed a retrospective analysis in 124 women treated between 1987-2007 in the framework of the Rare-Cancer-Network. Median follow-up was 27 months. Postoperative pelvic EBRT was administered in 105 women (85%) and 92 patients (74%) received exclusive or additional vaginal brachytherapy. Five-year overall survival (OS), disease-free survival (DFS), cancer specific survival (CSS) and locoregional control (LRC) were 51.6% (95% CI 35-73%), 53.7% (39-71%), 58.6% (38-74%) and 48% (38-67%). Multivariate analysis showed that external beam radiation therapy (EBRT) >50Gy was an independent prognostic factor for better OS (P=0.03), CSS (P=0.02) and LRC (P=0.01). Relative risks (RR) for better OS (P=0.02), DFS (P=0.04) and LRC (P=0.01) were significantly associated with younger age (≤60 years). Higher brachytherapy (BT)-dose (>9Gy) improved DFS (P=0.04) and LRC (P=0.008). We concluded that UCS has high systemic failure rate. Local relapse was reduced by a relative risk factor of over three in all stages of diseases when using higher doses for EBRT and brachytherapy. Postoperative RT was most effective in UCS stage I/II-diseases.

Treatment and Outcome of Patients with Uterine Carcinosarcoma in a Comprehensive Cancer Network

“…In contrast, the latter study showed that postoperative RT resulted in a 5-year OS of 51.6% (95% CI 35-73%) and cancer-specific survival (CSS) of 58.6% (95% CI 38-74%), showing one of the highest OS and CSS in the literature to date. However, these findings should also be interpreted with caution due to small cohort size and potential selection bias [18]. In summary, the effect of postoperative adjuvant RT of UCS remains controversial, some studies only report local Fig.…”

Uterine Carcinosarcoma: A Case Report and Literature Review

“…On CT, the tumors present as ill-defined hypodense mass(es) with dilation of the endometrial cavity in most cases [ 7 ]. Uterine carcinosarcoma can metastasize to a wide variety of organs, including the lungs (49%), peritoneum (44%), bones (17%), and liver (15%), as well as the central nervous system (8%), with the latest being associated with poor prognosis [ 20 , 21 ]. Staging of the endometrial cancers is summarized in Table 1 [ 22 ].…”

“…3 Case Reports in Obstetrics and Gynecology (8%), with the latest being associated with poor prognosis [20,21]. Staging of the endometrial cancers is summarized in Table 1 [22].…”

Spinal intramedullary uterine carcinosarcoma metastasis

“…Similarly, uterine carcinosarcoma is rare and aggressive, with a survival expectancy of less than 5 years in two-thirds of patients. It typically manifests with distant metastases, primarily targeting the lungs, followed by the peritoneum, bones and muscles, liver and, to a lesser extent, the brain 5–7. Individuals with brain metastasis typically undergo surgical or stereotactic radiosurgical treatment, followed by adjuvant whole-brain radiotherapy.…”