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Impact of Treatment Strategies on Local Control and Survival in Uterine Carcinosarcomas in Turkey

  • Kucukoztas, Nadire (Department of Medical Oncology, Baskent University Hospital) ;
  • Dizdar, Omer (Department of Medical Oncology, Baskent University Hospital) ;
  • Rahatli, Samed (Department of Medical Oncology, Baskent University Hospital) ;
  • Dursun, Polat (Department of Obstetrics and Gynecology, Baskent University Hospital) ;
  • Yalcin, Selim (Department of Medical Oncology, Baskent University Hospital) ;
  • Altundag, Ozden (Department of Medical Oncology, Baskent University Hospital) ;
  • Ozen, Ozlem (Department of Pathology, Baskent University Hospital) ;
  • Reyhan, Nihan Haberal (Department of Pathology, Baskent University Hospital) ;
  • Tarhan, Cagla (Department of Radiology, Baskent University Hospital) ;
  • Yildiz, Ferah (Department of Radiation Oncology, Hacettepe University Institute of Oncology) ;
  • Ayhan, Ali (Department of Obstetrics and Gynecology, Baskent University Hospital)
  • Published : 2013.05.30

Abstract

Background: The purpose of this study was to determine the clinical characteristics, patterns of recurrence and survival outcomes in patients with uterine carcinosarcomas treated in our institution. Materials and Methods: Records of 26 patients diagnosed between 2007 and 2011 with uterine carcinosarcoma were retrospectively evaluated for demographic features, tumor characteristics, treatment regimens and patient outcomes in terms of DFS and OS Results: Median age was 61 (range 43-78). 10 patients (38%) had stage I disease at diagnosis, 3 (12%) had stage II, 4 (15%) had stage III and 9 (35%) had stage IV. Sixteen patients (62%) received chemotherapy with paclitaxel and carboplatin for 6 cycles. One patient underwent radiotherapy. Median follow up was 17 months. Sixteen patients relapsed and 13 died during follow up. Considering recurrence, 5 out of 16 patients had lung metastases, one had brain metastases and 9 had only intraabdominal recurrence. The 3 year DFS was 37% and the 3 year OS was 30%. Conclusions: Our data show that uterine carcinosarcomas tend to be at advanced stage at diagnosis and despite the use of chemotherapy, overall prognosis is poor. Surgery remains the mainstay of treatment. More effective adjuvant strategies are needed to reduce relapse and death rates.

Keywords

Uterine carcinosarcoma;treatment;survival;Turkey

References

  1. Arend R, Doneza JA, Wright JD (2011). Uterine carcinosarcoma. Curr Opin Oncol, 23, 531-6.
  2. Brown E, Stewart M, Rye T, et al (2004). Carcinosarcoma of the ovary: 19 years of prospective data from a single center. Cancer, 100, 2148-53. https://doi.org/10.1002/cncr.20256
  3. Clayton SD, Kenneth MO, Gaffney DK, et al (2008). The impact of adjuvant radiation therapy on survival in women with uterine carcinosarcoma. Radiother Oncol, 88, 227-32. https://doi.org/10.1016/j.radonc.2007.11.029
  4. Denschlag D, Masoud I, Stanimir G, et al (2007). Prognostic factors and outcome in women with uterine sarcoma. Eur J Surg Oncol, 33, 91-5. https://doi.org/10.1016/j.ejso.2006.11.012
  5. Einstein MH, Klobocista M, Hou JY, et al (2012). Phase II trial of adjuvant pelvic radiation “sandwiched” between ifosfamide or ifosfamide plus cisplatin in women with uterine carcinosarcoma. Gynecol Oncol, 124, 26-30. https://doi.org/10.1016/j.ygyno.2011.10.008
  6. Ferrer F, Sabater S, Farrus B, et al (1999). Impact of radiotherapy on local control and survival in uterine sarcomas: a retrospective study from the Group Oncologic Catala-Occita. Int J Radiat Oncol Biol Phys, 44, 47-52. https://doi.org/10.1016/S0360-3016(98)00515-X
  7. Gadducci A, Cosio S, Romanini A, Genazzani AR (2008). The management of patients with uterine sarcoma: a debated clinical challenge. Crit Rev Oncol Hematol, 65, 129-42. https://doi.org/10.1016/j.critrevonc.2007.06.011
  8. Gonzalez BJ, Terstriep SA, Cliby WA, et al (2010). The impact of multi-modal therapy on survival for uterine carcinosarcomas. Gynecol Oncol, 116, 419-23. https://doi.org/10.1016/j.ygyno.2009.10.053
  9. Homesley HD, Filiaci V, Markman M, et al (2007). Phase III trial of ifosfamide with or without paclitaxel in advanced uterine carcinosarcoma: a gynecologic oncology group study. J Clin Oncol, 25, 526-31. https://doi.org/10.1200/JCO.2006.06.4907
  10. Hoskins PJ, Le N, Ellard S, et al (2008). British columbia cancer agency. Carboplatin plus paclitaxel for advanced or recurrent uterine malignant mixed mullerian tumors. the british columbia cancer agency experience. Gynecol Oncol, 108, 58-62. https://doi.org/10.1016/j.ygyno.2007.08.084
  11. Makker V, Abu-Rustum NR, Alektiar KM, et al (2008). A retrospective assessment of outcomes of chemotherapybased versus radiation-only adjuvant treatment for completely resected stage I-IV uterine carcinosarcoma. Gynecol Oncol, 111, 249-54. https://doi.org/10.1016/j.ygyno.2008.06.035
  12. McCluggage WG (2002). Uterine carcinosarcomas (malignant mixed Mullerian tumors) are metaplastic carcinomas. Int J Gynecol Cancer, 12, 687-90. https://doi.org/10.1046/j.1525-1438.2002.01151.x
  13. Menczer J, Levy T, Piura B, et al (2005). A comparison between different postoperative treatment modalities of uterine carcinosarcoma. Gynecol Oncol, 97, 166-70. https://doi.org/10.1016/j.ygyno.2004.12.006
  14. Miller DS, King LP (2008). Gynecologic oncology group trials in uterine corpus malignancies: recent progress. J Gynecol Oncol, 19, 218-22. https://doi.org/10.3802/jgo.2008.19.4.218
  15. Nemani D, Mitra N, Guo M, et al (2008). Assessing the effects of lymphadenectomy and radiation therapy in patients with uterine carcinosarcoma: a SEER analysis. Gynecol Oncol, 111, 82-8. https://doi.org/10.1016/j.ygyno.2008.05.016
  16. Powell MA, Filiaci VL, Rose PG, et al (2010). Phase II evaluation of paclitaxel and carboplatin in the treatment of carcinosarcoma of the uterus: a Gynecologic Oncology Group study. J Clin Oncol, 28, 2727-31. https://doi.org/10.1200/JCO.2009.26.8326
  17. Reed NS, Mangioni C, Malmstrom H, et al (2008). European organisation for research and treatment of cancer gynaecological cancer group. Phase III randomised study to evaluate the role of adjuvant pelvic radiotherapy in the treatment of uterine sarcomas stages I and II: an European organisation for research and treatment of cancer gynaecological cancer group study (protocol 55874). Eur J Cancer, 44, 808-18. https://doi.org/10.1016/j.ejca.2008.01.019
  18. Tanner EJ, Leitao MM Jr, Garg K, et al (2011). The role of cytoreductive surgery for newly diagnosed advanced-stage uterine carcinosarcoma. Gynecol Oncol, 123, 548-52. https://doi.org/10.1016/j.ygyno.2011.08.020
  19. Toyoshima M, Akahira J, Matsunaga G, et al (2004). Clinical experience with combination paclitaxel and carboplatin therapy for advanced or recurrent carcinosarcoma of the uterus. Gynecol Oncol, 94, 774-8. https://doi.org/10.1016/j.ygyno.2004.05.048
  20. Sutton G, Brunetto VL, Kilgore L, et al (2000). A phase III trial of ifosfamide with or without cisplatin in carcinosarcoma of the uterus: a gynecologic oncology group study. Gynecol Oncol, 79, 147-53. https://doi.org/10.1006/gyno.2000.6001
  21. Sutton G, Kauderer J, Carson LF, et al (2005). Gynecologic oncology group. Adjuvant ifosfamide and cisplatin in patients with completely resected stage I or II carcinosarcomas (mixed mesodermal tumors) of the uterus: a gynecologic oncology group study. Gynecol Oncol, 96, 630-4. https://doi.org/10.1016/j.ygyno.2004.11.022
  22. Wolfson AH, Brady MF, Rocereto T, et al (2007). A gynecologic oncology group randomized phase III trial of whole abdominal irradiation (WAI) vs. cisplatin-ifosfamide and mesna (CIM) as post-surgical therapy in stage I-IV carcinosarcoma (CS) of the uterus. Gynecol Oncol, 107, 177-85. https://doi.org/10.1016/j.ygyno.2007.07.070
  23. Wong L, See HT, Khoo-Tan HS, et al (2006). Combined adjuvant cisplatin and ifosfamide chemotherapy and radiotherapy for malignant mixed mullerian tumors of the uterus. Int J Gynecol Cancer, 16, 1364-9 https://doi.org/10.1111/j.1525-1438.2006.00560.x

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