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

Abstract

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.

Outcome analysis in patients with uterine sarcoma

“…Since higher pelvic failure rates in CS were also seen in our study, we performed subgroup analysis of CS patients and could determine the benefit of WPRT in achieving pelvic control in CS patients. Several other studies also report the benefit of WPRT in achieving local control for CS patients [ 7 , 16 , 19 ], which is consistent with our study. MD Anderson Cancer Center reviewed 300 patients with stage I to III CS and found that adjuvant pelvic RT decreased the risk of pelvic recurrence and delayed distant metastasis [ 7 ].…”

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

“…Although no survival benefit was associated with RT, a marked decrease in the locoregional failure rate was observed in patients with UCS, with local recurrence rates of 47% and 24% in the observation and RT arms, respectively. In addition, several retrospective single institutional studies [61314] and large-scale nationwide database studies [1516] have evaluated the impact of adjuvant RT on UCS. In most of these studies, adjuvant RT significantly reduced local failure, although OS and distant metastasis were not affected.…”

Primary splenic carcinosarcoma with local invasion of chest wall: a rare case

“…Adjuvant radiotherapy has been used to treat carcinosarcoma (Park et al, 2011). However, its value in addition to systemic treatment remains ill-defined (Dave et al, 2011).…”

“…However, its value in addition to systemic treatment remains ill-defined (Dave et al, 2011). Park et al (2011) investigated the influence of adjuvant radiotherapy on patterns of failure and survivals in uterine carcinosarcoma, and indicated that adjuvant radiotherapy after surgical resection was effective in decreasing loco-regional recurrence, and most treatment failures were due to distant metastasis. The combined chemoradiotherapeutic approach has also been adopted and has shown survival benefit for uterine carcinosarcoma patients (Galaal et al, 2009).…”