DOI QR코드

DOI QR Code

The reasonable timing of the adjuvant radiotherapy in the treatment of uterine carcinosarcoma according to the surgical intent: suggestion based on progression patterns

  • Yu, Jeong Il (Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Choi, Doo Ho (Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Huh, Seung Jae (Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Park, Won (Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Oh, Dongryul (Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Bae, Duk Soo (Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • Received : 2013.02.01
  • Accepted : 2013.04.24
  • Published : 2013.06.30

Abstract

Purpose: We designed this study to identify and suggest the reasonable timing of adjuvant radiotherapy in the treatment of uterine carcinosarcoma according to the surgical intent and patterns of progression. Materials and Methods: We retrospectively analyzed a total of 50 carcinosarcoma patients diagnosed between 1995 and 2010. Among these 50 patients, 32 underwent curative surgery and 13 underwent maximal tumor debulking surgery. The remaining five patients underwent biopsy only. Twenty-six patients received chemotherapy, and 15 patients received adjuvant radiotherapy. Results: The median follow-up period was 17.3 months. Curative resection (p < 0.001) and stage (p < 0.001) were statistically significant factors affecting survival. During follow-up, 30 patients showed progression. Among these, eight patients (16.0%) had loco-regional progression only. The patients who had received adjuvant radiotherapy did not show loco-regional progression, and radiotherapy was a significant negative risk factor for loco-regional progression (p = 0.01). The time to loco-regional progression was much earlier for non-curative than curative resection (range, 0.7 to 7.6 months vs. 7.5 to 39.0 months). Conclusion: Adjuvant radiotherapy in the treatment of carcinosarcoma might be related to a low loco-regional progression rate. Radiotherapy should be considered in non-curatively resected patients as soon as possible.

Keywords

References

  1. Robinson-Bennett B, Belch RZ, Han AC. Loss of p16 in recurrent malignant mixed mullerian tumors of the uterus. Int J Gynecol Cancer 2006;16:1354-7. https://doi.org/10.1111/j.1525-1438.2006.00411.x
  2. Teo SY, Babagbemi KT, Peters HE, Mortele KJ. Primary malignant mixed mullerian tumor of the uterus: findings on sonography, CT, and gadolinium-enhanced MRI. AJR Am J Roentgenol 2008;191:278-83. https://doi.org/10.2214/AJR.07.3281
  3. Nielsen SN, Podratz KC, Scheithauer BW, O'Brien PC. Clinicopathologic analysis of uterine malignant mixed mullerian tumors. Gynecol Oncol 1989;34:372-8. https://doi.org/10.1016/0090-8258(89)90176-5
  4. Silverberg SG, Major FJ, Blessing JA, et al. Carcinosarcoma (malignant mixed mesodermal tumor) of the uterus: a Gynecologic Oncology Group pathologic study of 203 cases. Int J Gynecol Pathol 1990;9:1-19. https://doi.org/10.1097/00004347-199001000-00001
  5. Pradhan TS, Stevens EE, Ablavsky M, Salame G, Lee YC, Abulafia O. FIGO staging for carcinosarcoma: can the revised staging system predict overall survival? Gynecol Oncol 2011;123:221-4. https://doi.org/10.1016/j.ygyno.2011.08.007
  6. Nemani D, Mitra N, Guo M, Lin L. Assessing the effects of lymphadenectomy and radiation therapy in patients with uterine carcinosarcoma: a SEER analysis. Gynecol Oncol 2008;111:82-8. https://doi.org/10.1016/j.ygyno.2008.05.016
  7. Callister M, Ramondetta LM, Jhingran A, Burke TW, Eifel PJ. Malignant mixed mullerian tumors of the uterus: analysis of patterns of failure, prognostic factors, and treatment outcome. Int J Radiat Oncol Biol Phys 2004;58:786-96. https://doi.org/10.1016/S0360-3016(03)01561-X
  8. Chi DS, Mychalczak B, Saigo PE, Rescigno J, Brown CL. The role of whole-pelvic irradiation in the treatment of early-stage uterine carcinosarcoma. Gynecol Oncol 1997;65:493-8. https://doi.org/10.1006/gyno.1997.4676
  9. Gerszten K, Faul C, Kounelis S, Huang Q, Kelley J, Jones MW. The impact of adjuvant radiotherapy on carcinosarcoma of the uterus. Gynecol Oncol 1998;68:8-13. https://doi.org/10.1006/gyno.1997.4901
  10. National Comprehensive Cancer Network. Recent updates to NCCN clinical practice guidelines in oncology (NCCN guidelines) [Internet]. Fort Washington, PA: National Comprehensive Cancer Network; [cited 2012 May 20]. Available from: http://www.nccn.org/professionals/physician_gls/recently_updated.asp.
  11. Creasman WT, Odicino F, Maisonneuve P, et al. Carcinoma of the corpus uteri. FIGO 26th Annual Report on the Results of Treatment in Gynecological Cancer. Int J Gynaecol Obstet 2006;95 Suppl 1:S105-43. https://doi.org/10.1016/S0020-7292(06)60031-3
  12. McCluggage WG. Uterine carcinosarcomas (malignant mixed mullerian tumors) are metaplastic carcinomas. Int J Gynecol Cancer 2002;12:687-90. https://doi.org/10.1046/j.1525-1438.2002.01151.x
  13. Tinkler SD, Cowie VJ. Uterine sarcomas: a review of the Edinburgh experience from 1974 to 1992. Br J Radiol 1993;66:998-1001.
  14. Gadducci A, Romanini A. Adjuvant chemotherapy in early stage uterine sarcomas: an open question. Eur J Gynaecol Oncol 2001;22:352-7.
  15. Tanner EJ, Leitao MM Jr, Garg K, et al. The role of cytoreductive surgery for newly diagnosed advanced-stage uterine carcinosarcoma. Gynecol Oncol 2011;123:548-52. https://doi.org/10.1016/j.ygyno.2011.08.020
  16. Homesley HD, Filiaci V, Markman M, et al. Phase III trial of ifosfamide with or without paclitaxel in advanced uterine carcinosarcoma: a Gynecologic Oncology Group Study. J Clin Oncol 2007;25:526-31. https://doi.org/10.1200/JCO.2006.06.4907
  17. Sutton G, Brunetto VL, Kilgore L, et al. A phase III trial of ifosfamide with or without cisplatin in carcinosarcoma of the uterus: a Gynecologic Oncology Group Study. Gynecol Oncol 2000;79:147-53. https://doi.org/10.1006/gyno.2000.6001
  18. Wolfson AH, Brady MF, Rocereto T, et al. 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 2007;107:177-85. https://doi.org/10.1016/j.ygyno.2007.07.070
  19. Powell MA, Filiaci VL, Rose PG, et al. Phase II evaluation of paclitaxel and carboplatin in the treatment of carcinosarcoma of the uterus: a Gynecologic Oncology Group study. J Clin Oncol 2010;28:2727-31.