Uterine carcinosarcomas: From pathology to practice

Toboni, Michael D.; Crane, Erin K.; Brown, Jubilee; Shushkevich, Alexander; Chiang, Sarah; Slomovitz, Brian M.; Levine, Douglas A.; Dowdy, Sean C.; Klopp, Ann H.; Powell, Matthew A.; Thaker, Premal H.

doi:10.1016/j.ygyno.2021.05.003

Cited by 15 publications

(24 citation statements)

References 61 publications

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“…43 Compared to IP or paclitaxel-ifosfamide regimen, advantages of the PP are convenience, less bone marrow suppression requiring growth factor support, a better cost profile, and less toxicity. 43,53 In the current study, we did not evaluate the aforementioned potential benefits, such as less myelosuppression, a better cost profile, or less toxicity, but we found that PP may have a possibly better therapeutic effect.…”

Section: Chemotherapy Regimenmentioning

confidence: 81%

“…36 Other studies also supported the rationale of using PP for UCS based on response rates from 55% to 64% in the upfront and recurrent settings. 51,52 Moreover, although not published yet, 53 the phase III GOG 0261 trial enrolling 537 patients with FIGO stage I to IVB UCS compared adjuvant PP vs paclitaxel-ifosfamide regimen, and the results showed the noninferiority of the PP to the paclitaxelifosfamide regimen in the evaluation of OS (median OS: 37 vs 29 months, HR, 0.87; 90% CI, 0.70-1.075) but seemed to offer a better PFS rate in PP (median PFS: 16 vs 12 months; HR 0.73; p < 0.01 for noninferiority, p < 0.01 for superiority). 43 Compared to IP or paclitaxel-ifosfamide regimen, advantages of the PP are convenience, less bone marrow suppression requiring growth factor support, a better cost profile, and less toxicity.…”

Section: Chemotherapy Regimenmentioning

confidence: 99%

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

Huang

et al. 2022

Journal of the Chinese Medical Association

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Malignant mixed Müllerian tumors (MMMT, carcinosarcomas [CS]) of female genital tract are defined histologically as a biphasic tumor consisting of both carcinoma (malignant epithelial elements) and sarcoma (malignant mesenchymal or stromal elements) components. 1-3 CS usually arises from the uterus but may also rarely appear in the ovary, Fallopian tube, cervix, or peritoneum. [4][5][6] In the past and traditionally, uterine CS (UCS) has been regarded as a subtype of uterine sarcomas and is often analyzed after grouping other uterine sarcomas, such as undifferentiated uterine sarcoma, endometrial stromal sarcoma, and leiomyosarcoma. [7][8][9][10] Recently, clinical, pathologic, and biological evidence has indicated that UCS is a monoclonal origin, which is derived from the Müllerian duct and closely related to high-grade endometrial carcinoma with the driving force to result in sarcomatous transformation (metaplastic carcinoma), and subsequently form the homologous or heterologous groups, depending on the characteristics of the stroma or mesenchymal components of endometrial tissues. [11][12][13] Primary complete surgical staging or primary cytoreductive surgery (PCS) is a key factor in the management of women with UCS, based on the studies obtained from the experience for high-grade or advanced endometrial cancer and uterine sarcomas as well as epithelial ovarian cancer, primary peritoneal serous carcinoma, and primary fallopian tube cancers. 10,14-21 PCS includes a total hysterectomy, bilateral salpingo-oophorectomy,

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Section: Chemotherapy Regimenmentioning

confidence: 81%

Section: Chemotherapy Regimenmentioning

confidence: 99%

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

Huang

et al. 2022

Journal of the Chinese Medical Association

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“…HER2 overexpression in UCS has also been studied recently, and ORRs were around 10–20% in UCS [ 6 , 49 , 50 ]. Although there is no clinical trial data using HER2-targeting agents in treating UCS, a phase II trial revealed that a trastuzumab add-on to carboplatin and paclitaxel prolonged PFS more than chemotherapy alone in stage III/IV HER2/neu over-expressed serous endometrial cancer [ 51 ].…”

Section: Discussionmentioning

confidence: 99%

“…UCS used to be categorized into sarcoma, as it has both a sarcomatous (mesenchymal) and a carcinomatous (epithelial) component [ 6 ]. It is now believed to be originated from a single endometrial tumor clone, which then underwent metaplastic differentiation (conversion hypothesis), rather than stemming from a simply “biphasic” tumor [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Management and Prognosis of Patients with Recurrent or Persistent/Progressive Uterine Carcinosarcoma

et al. 2022

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Uterine carcinosarcoma (UCS) is a highly aggressive gynecologic malignancy. Recurrent or persistent/progressive disease is usually fatal. We aimed to investigate the management and prognosis of these patients. Clinical records of UCS patients from June 1987 to April 2020 were retrospectively reviewed. The stage was re-assigned with the FIGO 2009 staging system. Univariate and multivariate analyses were used to identify the independent predictors of survival after recurrence (SAR) and cancer-specific survival (CSS). Of the 168 patients, 98 experienced treatment failure. The median time to treatment failure (TTF) was 8.1 months (range: 0.0–89.1). The median follow-up time of censored patients was 32.0 months (range: 16.8–170.7). The 5-year SAR rates of those with recurrent or persistent/progressive disease were 7.6%. On multivariate analysis, salvage therapy mainly using radiotherapy (HR 0.27, 95% CI: 0.10–0.71) or chemotherapy (HR 0.41, 95% CI: 0.24–0.72) or chemoradiotherapy (CRT) (HR 0.33, 95% CI: 0.15–0.75) were associated with improved SAR, whereas disseminated recurrence was associated with significantly worse SAR (HR 3.94, 95% CI: 1.67–9.31, p = 0.002). Salvage therapy using radiotherapy or chemotherapy or CRT significantly improved SAR. Surgery significantly improved CSS but not SAR, adjusting for confounding factors.

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“…ECS are characterised by a biphasic growth of malignant epithelial (carcinomatous) and mesenchymal (sarcomatous) components which could be of diverse histological origin: homologous (endometrial stromal sarcoma, fibrosarcoma, leiomyosarcoma) or heterologous (osseous, cartilaginous, and rhabdomyoblastic) cells [ 3 ]. Clinically, ECS cannot be distinguished from endometrial carcinoma or uterine sarcoma.…”

Section: Introductionmentioning

confidence: 99%

Endometrial carcinosarcoma: a poor prognosis debut with favourable therapeutic outcome

Toro-Wills¹,

Álvarez-Londoño²,

Hernández-Blanquisett³

et al. 2022

ecancer

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Endometrial carcinosarcoma (ECS) is a rare, highly aggressive disease characterised by a biphasic growth of malignant epithelial (carcinomatous) and mesenchymal (sarcomatous) components. Clinically, it cannot be distinguished from endometrial carcinoma or uterine sarcoma. The definitive diagnosis can only be made based on histological examination and immunohistochemistry. To date, there aren't standardised treatment protocols for its management. We report a case of a 73-year-old patient who presented postmenopausal abnormal uterine bleeding and was diagnosed with ECS. A non-conventional treatment approach was conducted with favourable oncological outcomes.

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Uterine carcinosarcomas: From pathology to practice

Cited by 15 publications

References 61 publications

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

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

Management and Prognosis of Patients with Recurrent or Persistent/Progressive Uterine Carcinosarcoma

Endometrial carcinosarcoma: a poor prognosis debut with favourable therapeutic outcome

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