Early Stage Uterine Carcinosarcoma Research Articles

Impact of Adjuvant Pelvic External Beam Radiotherapy or Vaginal Brachytherapy on Clinical Outcomes for Early-Stage Uterine Carcinosarcoma

<h3>Purpose/Objective(s)</h3> Uterine carcinosarcoma (UCS) is an uncommon but aggressive malignancy with poor prognosis. There is no clear consensus regarding adjuvant radiotherapy (RT) following surgical management for patients (pts) with early stage UCS. We compared outcomes for pts with early stage UCS who underwent adjuvant pelvic external beam RT (EBRT) vs. vaginal brachytherapy (VBT) alone. <h3>Materials/Methods</h3> We conducted an Institutional Review Board-approved single institution retrospective study of 98 pts diagnosed with FIGO stage I-II UCS from 2002 to 2020 and received adjuvant RT, with or without chemotherapy (CT), following definitive surgery. EBRT dose was 45-50.4 Gy alone or followed by VBT boost of 10-18 Gy in 2-4 fractions (fx). Dose for adjuvant VBT alone was 21 Gy in 3 fx or 24 Gy in 6 fx, prescribed to the vaginal surface. We recorded clinical and treatment characteristics and clinical outcomes, including dates and location of progression. Fisher exact tests were used for categorical variables. PFS and OS were analyzed by Kaplan-Meier method and log-rank test. Univariate analyses (UVA) were performed using Cox proportional hazards modeling. <h3>Results</h3> 38 received CT+EBRT, 31 received CT+VBT, and 29 received RT alone (18 EBRT, 11 VBT). Fewer pts in the CT+EBRT and RT-alone groups received nodal sampling compared to pts in the CT+VBT group (<i>P</i>=0.02). Other factors including age, comorbidities, FIGO stage, and pathology were not different between the three groups. Median follow up was 93.5, 50.2, and 143.0 months for CT+EBRT, CT+VBT, and RT-alone groups, respectively. 3-year PFS was 78.7%, 67.6%, and 58.2% for CT+EBRT, CT+VBT, and RT alone, respectively. EBRT+CT significantly improved PFS (P=0.01) compared to RT alone (P=0.01), but not compared to CT+VBT (P=0.22). In terms of locoregional recurrences, 1 pt had a vaginal recurrence and 3 had pelvic nodal recurrences after CT+EBRT. In the CT+VBT cohort, 4 pts had vaginal recurrences, 3 had pelvic nodal recurrences, and 1 had a pelvic soft-tissue recurrence. In the RT-alone group, 1 pt receiving VBT suffered a vaginal recurrence, and 4 pts receiving EBRT had pelvic nodal recurrences. UVA showed that compared to CT+EBRT, RT alone was associated with shorter time to progression (HR 2.50, 95% CI 1.08-5.79, <i>P</i>=0.03) but CT+VBT was not (HR 1.82, 95% CI 0.74-4.50, <i>P=</i>0.20). Other factors including age, stage, nodal sampling, and lymphovascular invasion were not significant on UVA. <h3>Conclusion</h3> In one of the largest retrospective cohorts of early stage UCS, we found adjuvant EBRT+CT improved outcomes compared to RT alone, but not CT+VBT. There were 5 vaginal recurrences in pts undergoing VBT, suggesting that VBT alone at the doses prescribed in this study may not be sufficient. Larger prospective studies and longer follow up are needed to further investigate differences in radiation modalities for the treatment of early-stage UCS. †In Memoriam: LJL, deceased June 23, 2021.

Effect of adjuvant therapy on the prognosis in stage I/II uterine carcinosarcoma: A meta-analysis.

To assess the efficacy of adjuvant chemotherapy, radiotherapy, or both following the primary surgery on the progression-free survival and 5-year overall survival in patients with stage I/II uterine carcinosarcoma. A preliminary investigation was conducted using PubMed and Embase databases to identify relevant studies published up to March, 2020. Pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated by Revman 5.3 software to analysis outcomes. Six retrospective cohort studies were involved in the analysis, including 1516 patients in observation group, 956 patients in chemotherapy group, 750 patients in radiotherapy group, and 1082 patients in raidochemotherapy group. The results indicated that chemotherapy alone (HR=0.59, 95% CI=0.38-0.91, p < 0.05) and radiochemotherapy (HR=0.35, 95% CI: 0.24-0.53, p < 0.001) were associated with improved progression-free survival in patients. Similarly, pooled results suggested chemotherapy (HR=0.49, 95% CI=0.34-0.71, p < 0.001) and radiochemotherapy (HR=0.46, 95% CI=0.29-0.72, p < 0.001) promoted the 5-year overall survival compared with observation. However, radiotherapy alone had no statistical significance in improving progression-free survival (HR=0.80, 95% CI=0.49-1.29, p=0.36) and 5-year overall survival (HR=0.65, 95% CI=0.38-1.12, p=0.12). Chemotherapy and radiochemotherapy appeared to be prognostic beneficial to early-stage uterine carcinosarcoma.

Adjuvant vaginal interventional radiotherapy in early-stage non-endometrioid carcinoma of corpus uteri: a systematic review.

PurposeThis systematic review focused on rare histological types of corpus uteri malignancy, including uterine carcinosarcoma (UCS), uterine clear cell carcinoma (UCCC), and uterine papillary serous carcinoma (UPSC), and it is proposed to assist with clinical decision-making. Adjuvant treatment decisions must be made based on available evidences. We mainly investigated the role of vaginal interventional radiotherapy (VIRt) in UCS, UCCC, and UPSC managements.Material and methodsA systematic research using PubMed and Cochrane library was conducted to identify full articles evaluating the efficacy of VIRt in early-stage UPSC, UCCC, and UCS. A search in ClinicalTrials.gov was performed in order to detect ongoing or recently completed trials as well as in PROSPERO for ongoing or recently completed systematic reviews. Survival outcomes and toxicity rates were obtained.ResultsAll studies were retrospective. For UCS, the number of evaluated patients was 432. The 2- to 5-year average local control (LC) was 91% (range, 74.2-96%), disease-free survival (DFS) 88% (range, 82-94%), overall survival (OS) 79% (range, 53.8-84.3%), the average 5-year cancer-specific survival (CSS) was 70% (range, 70-94%), and G3-G4 toxicity was 0%. For UCCC, the number of investigated patients was 335 (UCCC – 124, mixed – 211), with an average 5-year LC of 100%, DFS of 83% (range, 82-90%), OS of 93% (range, 83-100%), and G3-G4 toxicity of 0%. For UPSC, the number of examined patients was 1,092 (UPSC – 866, mixed – 226). The average 5-year LC was 97% (range, 87.1-100%), DFS 84% (range, 74.7-95.6%), OS 93% (range, 71.9-100%), CSS 89% (range, 78.9-94%), and G3-G4 toxicity was 0%.ConclusionsThese data suggest that in adequately selected early-stage UPSC and UCCC patients, VIRt alone may be suitable in women who underwent surgical staging and received adjuvant chemotherapy. In early-stage UCS, a multidisciplinary therapeutic approach has to be planned, considering high-rate of pelvic and distant relapses.

Is the Oncological Outcome of Early Stage Uterine Carcinosarcoma Different from That of Grade 3 Endometrioid Adenocarcinoma?

Aim: The clinicopathologic characteristics, recurrence patterns, and survival of patients with grade 3 endometrial cancer (G3-EAC) and uterine carcinosarcoma (UCS) were compared. Materials and Methods: The medical records of patients treated for G3-EAC and UCS between January 1996 and December 2016 at 11 gynecologic oncology centers in Turkey and Germany were analyzed. Results: Of all patients included in the study, 161 (45.1%) were diagnosed with UCS and 196 (54.9%) with G3-EAC at FIGO stage I–II (early stage) disease. The recurrence rate was higher in patients with UCS than in those with G3-EAC (17.4 vs. 9.2%, p = 0.02). The 5-year disease-free survival (DFS; 75.2 and 80.8%, respectively; p = 0.03) and overall survival (OS; 79.4 and 83.4%, respectively; p = 0.04) rates were significantly lower in the UCS group compared to the G3-EAC group. UCS histology was an independent prognostic factor for decreased 5-year DFS (HR 1.8, 95% CI 1.2–3.2; p = 0.034) and OS (HR 2.7, 95% CI 1.3–6.9; p = 0.041) rates. Conclusions: The recurrence rate was higher in UCS patients than in G3-EAC patients, regardless of disease stage. DFS and OS were of shorter duration in UCS than in G3-EAC patients. Adequate systematic lymphadenectomy and omentectomy were an independent prognostic factor for increased 5-year DFS and OS rates.

Adjuvant Vaginal Cuff Brachytherapy and Patterns of Failure for Early Stage Uterine Carcinosarcoma

Uterine carcinosarcoma (UCS) is a rare histologic type, for which the optimal adjuvant management has not been fully established. In this study, we evaluated treatment outcomes and patterns of failure in patients with FIGO stage I-II UCS. After IRB approval, our prospectively-maintained database for women with endometrial carcinoma was queried. Seventy-four women with early stage UCS who underwent surgical staging between August 1992 and January 2018 at our institution were identified. After surgery, patients were managed with observation, chemotherapy (CT) alone, radiotherapy (RT) alone, or both CT and RT (CRT). Wilcoxon Rank test and Chi-Squared Test of Independence were used to assess the effect of treatment modality on various clinical parameters. The Kaplan-Meier product-limit method was used to calculate the rates of relapse-free survival (RFS), disease-specific survival (DSS), and overall survival (OS). Univariate and multivariate analyses were employed to identify significant predictors for the survival rates. Median follow-up duration was 51 months (range, 5.1-291.6 months). The median age was 67.0 years. Distribution of FIGO stages was as follows: 48 women (65%) with FIGO stage IA, 17 (23%) IB, and 9 (12%) II. After surgery, 8 (11%) patients received RT alone, 19 (26%) had CT alone, 28 (38%) were treated with CRT, and 19 (26%) were clinically observed and did not receive any adjuvant therapy. All women who had RT received it in the form of high-dose rate (HDR) vaginal cuff brachytherapy alone (median surface dose of 30 Gy in 5 fractions) using a single channel vaginal cylinder. For patients who received chemotherapy, a median of 6 cycles (range, 3-6 cycles) of carboplatin and paclitaxel were administered. As of the most recent follow-up, 25 (34%) patients experienced recurrence of disease: 3 in the vagina only, 1 in the pelvic region only, 4 in both vagina and pelvic region, 1 in paraaortic region, and 16 in distant sites. Wilcoxon Rank test and Chi-Squared Test of Independence showed that neither the rate nor location of recurrence could be predicted by the modality of adjuvant therapy (p>0.05). Five-year OS was 66%, 38%, 81%, and 35%, respectively for CT alone, RT alone, CRT, and observation, respectively (p=0.008). Five-year RFS was 67%, 73%, 76%, and 44%, respectively for CT alone, RT alone, CRT, and observation, respectively (p=0.16). Five-year DSS was 76%, 71%, 81%, and 45%, respectively for CT alone, RT alone, CRT, and observation, respectively (p=0.07). Our results suggest that adjuvant vaginal cuff brachytherapy combined with chemotherapy for women with early stage uterine carcinosarcoma is likely to produce the best survival outcome, but a larger study is needed to further confirm the benefits.

Effect of Adjuvant Therapy on Oncologic Outcomes of Surgically Confirmed Stage I Uterine Carcinosarcoma: a Turkish Gynecologic Oncology Study

Background:Uterine carcinosarcoma is rare neoplasm that mostly presents as metastatic disease. Stage is one of the most important prognostic factor, however, the management of the early stage uterine carcinosarcoma is still controversial.Aims:To evaluate prognostic factors, treatment options, and survival outcomes in patients with surgically approved stage I uterine carcinosarcoma.Study Design:Cross-sectional study.Methods:Data of 278 patients with uterine carcinosarcoma obtained from four gynecologic oncology centers were reviewed, and 70 patients with approved stage I uterine carcinosarcoma after comprehensive staging surgery were studied.Results:The median age of the entire cohort was 65 years (range; 39-82). All patients underwent both pelvic and paraaortic lymphadenectomy. Forty-one patients received adjuvant therapy. The median follow-up time was 24 months (range; 1-129). Nineteen (27.1%) patients had disease failure. The 3-year disease-free survival and cancer-specific survival of the entire cohort was 67% and 86%, respectively. In the univariate analysis, only age was significantly associated with disease-free survival (p=0.022). There was no statistical significance for disease-free survival between observation and receiving any type of adjuvant therapy following staging surgery. Advanced age (<75 vs ≥75 years) was the only independent prognostic factor for recurrence (hazard ratio: 3.8, 95% CI=1.10-13.14, p=0.035) in multivariate analysis. None of the factors were significantly associated with cancer-specific survival.Conclusion:Advanced age was the only independent factor for disease-free survival in stage I uterine carcinosarcoma. Performing any adjuvant therapy following comprehensive lymphadenectomy was not related to the improved survival of the stage I disease.

Adjuvant Vaginal Cuff Brachytherapy and Patterns of Failure for Early Stage Uterine Carcinosarcoma

Adjuvant Vaginal Cuff Brachytherapy and Patterns of Failure for Early Stage Uterine Carcinosarcoma

Prognostic factors impacting survival in early stage uterine carcinosarcoma

ObjectiveEvaluate the impact of clinicopathologic characteristics and adjuvant treatment on survival outcomes in early stage uterine carcinosarcoma patients. MethodsWe performed a retrospective cohort study of women with stage I or II uterine carcinosarcoma at our institution between March 1990 and June 2016. All pathology had been reviewed and confirmed by gynecologic pathologists. Data were extracted from the electronic medical record. Descriptive and comparative statistics were used to compare clinicopathologic characteristics. Univariable and multivariable analyses were performed for survival outcomes. Results140 patients were identified. Median age was 67 years (range: 36–91). Median follow-up was 39.1 months (2.9–297.4). The majority of patients had stage IA (67%) versus stage IB (21%) or stage II (11%) disease. The majority of patients (63%) received adjuvant treatment: vaginal brachytherapy only (14%); whole pelvic radiation therapy only (16%); chemotherapy only (n = 13, 9%); combination chemotherapy and vaginal brachytherapy (15%); combination chemotherapy and whole pelvic radiation (9%). 52 patients (37%) received no adjuvant therapy. Median overall survival (OS) was 48.0 months (95% CI 32.7–80.9). On multivariable analysis for OS, advancing age (HR 1.05, 95% CI 1.03–1.08, p < 0.001), higher stage (stage IB: HR 1.64, 95% CI 0.91–2.95, p = 0.10; stage II: HR 3.04, 95% CI 1.51–6.13, p = 0.002), and the presence of a rhabdomyosarcoma component (HR 1.66, 95% CI 1.02–2.70, p = 0.04) were significantly associated with worse OS. ConclusionsAdvancing age, stage, and the presence of a rhabdomyosarcoma component were all associated with worse OS in patients with early stage uterine carcinosarcoma. New treatment algorithms should incorporate factors aside from stage alone.

Uterine Carcinosarcoma in A Postmenopausal Woman: A Rare Case Report

Uterine carcinosarcomas are rare tumors accounting for about 2–4% of all uterine cancer and with a poor prognosis with 5-year survival of only 21–39%. These are highly aggressive tumors and usually diagnosed with distant metastasis at the initial diagnosis. The origin of this tumor has been studied extensively, and these are now believed to be metaplastic carcinomas. The treatment of the early-stage disease is surgery, and in the late stages the role of adjuvant chemotherapy and radiotherapy is debated. We report here a case of the early-stage uterine carcinosarcoma in a postmenopausal woman.

The Impact of Adjuvant Therapy on Survival and Recurrence Patterns in Women With Early-Stage Uterine Carcinosarcoma: A Multi-institutional Study.

The aim of the study was to characterize the impact of adjuvant therapy on survival in women with stage I/II uterine carcinosarcoma after primary surgery. We reviewed records of 118 consecutively treated women with 2009 International Federation of Gynecology and Obstetrics stage I/II uterine carcinosarcoma who underwent hysterectomy between 1990 and 2014 at 4 academic institutions. Patients were categorized by adjuvant treatment group into observation, chemotherapy only, radiation only, and combined chemotherapy and radiation. Survival analyses were conducted using Kaplan-Meier and Cox proportional hazards models. Median follow-up was 28 months (range, 1-244 months). Lymphadenectomy was performed in 94 patients (80%). Postoperative management included observation (n = 37 [31%]), chemotherapy alone (n = 19 [16%]), radiation therapy (RT) alone (n = 24 [20%]), and combined RT and chemotherapy (n = 38 [32%]). Radiation therapy modality included vaginal brachytherapy in 22 patients, pelvic external beam RT in 21 patients, and combination in 19 patients. In 58% of women, chemotherapy consisted of carboplatin/paclitaxel. Median overall survival for all women was 97 months. On univariate analysis, adjuvant treatment group was associated with improved overall survival (hazard ratio [HR], 0.74; confidence interval [CI], 0.58-0.96; p = 0.02), freedom from vaginal recurrence (HR, 0.55; CI, 0.37-0.82]; p = 0.004), and freedom from any recurrence (HR, 0.70; CI, 0.54-0.92; p = 0.01). Pairwise comparisons demonstrated a significant benefit to chemoradiation over other adjuvant treatments. Adjuvant treatment group remained a significant covariate for all 3 end points on multivariate analysis as well. In addition, lymphadenectomy improved overall survival on multivariate analysis (HR, 0.24; CI, 0.09-0.61; p = 0.003). Of patients under observation only who had a recurrence, 8 (44%) of 18 had a recurrence in the vagina as the sole site of recurrence. By contrast, of women who received vaginal brachytherapy, significantly fewer had a recurrence in the vagina (1/42 [2.3%]; p < 0.003, log-rank test). In women with early-stage uterine carcinosarcoma, our data suggest superior survival end points with combined RT and chemotherapy. The frequency of vaginal recurrence suggests a role for incorporating vaginal brachytherapy in the adjuvant management of this disease.

The Impact of Adjuvant Therapy on Survival Endpoints in Women With Early-Stage Uterine Carcinosarcoma: A Multi-institutional Study

The Impact of Adjuvant Therapy on Survival Endpoints in Women With Early-Stage Uterine Carcinosarcoma: A Multi-institutional Study

The Influence of Adjuvant Radiation Therapy Modality on Outcomes for Early-Stage Uterine Carcinosarcoma in a Large Population-Based Cohort

The Influence of Adjuvant Radiation Therapy Modality on Outcomes for Early-Stage Uterine Carcinosarcoma in a Large Population-Based Cohort

Comparison of outcomes in early stage uterine carcinosarcoma and uterine serous carcinoma

ObjectiveTo assess whether contemporary adjuvant management of early stage uterine carcinosarcoma (CS) produces equal outcomes as in uterine serous carcinoma (USC). MethodsWe reviewed 172 women treated from 2000 to 2011 for stage I–II USC (n=112, 65%) or CS (n=60, 35%). Adjuvant therapy was initiated in 154 (90%) patients, with 111 patients receiving intravaginal radiotherapy (IVRT)/chemotherapy. Median follow up was 4.6years for surviving patients. ResultsCharacteristics for USC vs. CS did not differ significantly by age ≥60, pelvic or para-aortic node sampling, stage, lymphovascular invasion, chemotherapy use, RT use or omission of adjuvant therapy. Outcomes were better for USC vs. CS in 5-year actuarial rates of recurrence [17% (C.I. 10–25%) vs. 45% (C.I. 31–59%), p<0.001],disease-related mortality (DRM) [11% (5–17%) vs. 30% (16–44%), p=0.016], and all-cause mortality [12% (C.I. 6–18%) vs. 34% (C.I. 20–48%), p=0.007]. In multivariable analysis, CS histology remained a significant predictor of risk for recurrence [HR 3.1 (C.I. 1.7–5.7), p<0.001], DRM [HR 2.4 (C.I. 1.1–5.1), p=0.024], and all-cause mortality [HR 2.4 (C.I. 1.2–4.8), p=0.012]. On sub-group analysis of 111 patients (77 USC, 34 CS) able to receive IVRT/chemotherapy, CS no longer was associated significantly with increased recurrence (29% vs. 15%, p=0.18), DRM (22% vs. 10%, p=0.39), or all-cause mortality (22% vs. 10%, p=0.45). ConclusionsCS was associated with worse outcomes than USC. However, that difference was not maintained in patients able to receive IVRT and chemotherapy. While intriguing, this result may be due in part to selection against rapid early relapsing CS patients in this group.

Patterns of care, predictors, and outcomes of chemotherapy in elderly women with early-stage uterine carcinosarcoma: A population-based analysis

Patterns of care, predictors, and outcomes of chemotherapy in elderly women with early-stage uterine carcinosarcoma: A population-based analysis

Patterns of care, predictors, and outcomes of chemotherapy in elderly women with early-stage uterine carcinosarcoma: A population-based analysis

ObjectiveTo examine the patterns of care, predictors, and impact of chemotherapy on survival in elderly women diagnosed with early-stage uterine carcinosarcoma. MethodsThe Surveillance, Epidemiology, and End Results (SEER)-Medicare database was used to identify women 65years or older diagnosed with stage I–II uterine carcinosarcomas from 1991 through 2007. Multivariable logistic regression and Cox-proportional hazards models were used for statistical analysis. ResultsA total of 462 women met the eligibility criteria; 374 had stage I, and 88 had stage II uterine carcinosarcomas. There were no appreciable differences over time in the percentages of women administered chemotherapy for early stage uterine carcinosarcoma (14.7% in 1991–1995, 14.9% in 1996–2000, and 17.9% in 2001–2007, P=0.67). On multivariable analysis, the factors positively associated with receipt of chemotherapy were younger age at diagnosis, higher disease stage, residence in the eastern part of the United States, and lack of administration of external beam radiation (P<0.05). In the adjusted Cox-proportional hazards regression models, administration of three or more cycles of chemotherapy did not reduce the risk of death in stage I patients (HR: 1.45, 95% CI: 0.83–2.39) but was associated with non-significant decreased mortality in stage II patients (HR: 0.83, 95% CI: 0.32–1.95). ConclusionsApproximately 15–18% of elderly patients diagnosed with early-stage uterine carcinosarcoma were treated with chemotherapy. This trend remained stable over time, and chemotherapy was not associated with any significant survival benefit in this patient population.

A multi-institutional cohort study of adjuvant therapy in stage I–II uterine carcinosarcoma

ObjectiveTo evaluate the impact of adjuvant post-operative therapy in women with early stage uterine carcinosarcoma. MethodsAfter IRB approval was obtained at all sites, a multi-center retrospective study of women with FIGO stage I–II uterine carcinosarcoma diagnosed from 1997 to 2007 was conducted. Post-operative treatment included observation (OBS), radiation (RT), chemotherapy (CT) alone or with RT (CT+RT). Data analyzed included demographic and pathologic factors, adjuvant therapy outcomes, and time-to-event information. The Kaplan–Meier method was used to estimate time-to-event functions. Cox regression modeling was used to examine the impact of selected covariates on progression free survival (PFS), and overall survival (OS). Results111 women were identified: 94 (85%) had stage I and 17 (15%) had stage II uterine carcinosarcoma. Forty-four women (40%) did not receive adjuvant therapy (OBS), 29 (26%) women had adjuvant CT, 23 (20%) women underwent RT and 15 (14%) women underwent RT+CT. Seventy-three patients were alive without disease and 38 had progressed or died at the close of data collection. In multivariate analysis, CT (p=0.003), LVSI (p<0.0001) and a pre-existing cancer (p=0.004) were most predictive of PFS. LVSI was predictive of shortened OS (p=0.01). ConclusionsIn women with FIGO stage I–II uterine carcinosarcoma, adjuvant chemotherapy is associated with improved PFS compared to radiation or observation alone. Ongoing clinical trials will clarify the role of chemotherapy in women with this disease.

Patterns of Failure for Conservatively Managed Surgical Stage I Uterine Carcinosarcoma

To evaluate patterns of failure and overall survival for patients with surgical stage I uterine carcinosarcoma managed conservatively without adjuvant therapy. A computerized database identified 27 patients whose conditions have been diagnosed with surgical stage I uterine carcinosarcoma from 1993 to 2002. Charts were abstracted for patient demographics, tumor characteristics, recurrence, and survival. Of 27 patients, 23(85%) did not receive adjuvant therapy after undergoing total abdominal hysterectomy, bilateral salpingo-oophorectomy, and pelvic and paraaortic lymphadenectomy. Five patients were stage IA, 14 were stage IB, and 4 were stage IC. Fourteen patients had either poorly differentiated endometrioid carcinoma alone or in combination with papillary serous carcinoma (61%) as their epithelial tumor component. The median nodal count was 9 (range, 3-21). Eleven patients are alive without evidence of disease with a median follow-up of 63 months (range, 12-164 months). Eleven patients had recurrence with a median time to recurrence of 13 months (range, 6-39 months), and all are dead of disease. Univariate analysis demonstrated that poorly differentiated epithelial or papillary serous histologic diagnosis was the only predictor variable associated with recurrence and, consequently, death (P = 0.04). Approximately 50% of patients with surgical stage I carcinosarcoma who are observed without adjuvant therapy will experience a recurrence. Because most patients will recur distantly, systemic chemotherapy should be considered for patients with early stage uterine carcinosarcoma.

Effect of treatment of patients with early-stage uterine carcinosarcoma

5516 Background: The treatment of early stage uterine carcinosarcoma is controversial. We sought to retrospectively review factors that influence progression and survival. Methods: A retrospective, multi-institution study of women diagnosed from 1997–2007 was performed. Postoperative treatment included either observation (OBS), RT (brachytherapy, whole pelvic, or combination), chemotherapy (CT) alone or with RT (CT+RT). Data collected included time to recurrence, overall survival, and sites of recurrence. Statistics included ANOVA and Kaplan Meier. Results: One hundred and forty-six patients were diagnosed with early stage (stages 1 and 2) uterine carcinocarcoma. The median age at diagnosis was 68 years (range:40–91). The majority (62%) were Caucasian, 49 (34%) were African-American and the remainder were other ethnicities. One hundred and seventeen had stage 1 disease and 29 had stage 2. The majority of patients (N = 54, 37 %) were observed, 36 (25%) were treated with CT, 31 (21%) were treated with RT and 17 (12%) were treated with CT + RT. The median progression free survival (PFS) for patients diagnosed with early stage disease was 16.7 months for the OBS cohort and 38.2 months for the CT cohort (p &lt; 0.01). Median overall survival was 23 months for the OBS cohort and 39.3 months for the CT cohort (p = 0.02). The cohorts that underwent RT or CT+RT had improved median progression free (29.9, 20 months) and overall survival (31.7, 20.8 months) as compared to the OBS cohort, however this was not a statistically significant difference. Conclusions: We report on the largest experience in the literature on early stage uterine carcinosarcoma and the first to show that women with early stage disease may benefit from adjuvant chemotherapy. The role of radiation therapy or combination chemotherapy and radiation could not be adequately assessed from this retrospective analysis, but a trend toward improved survival was present. Prospective trials evaluating the best treatment for patients with early stage carcinosarcoma of the uterus should be undertaken to better answer this question. No significant financial relationships to disclose.

The Role of Whole-Pelvic Irradiation in the Treatment of Early-Stage Uterine Carcinosarcoma

Thirty-eight patients with Stage I and II uterine carcinosarcoma were treated by surgery with and without whole-pelvic irradiation (WPI) at our institution from 1975 to 1993. Ten patients (8 Stage I and 2 Stage II) were treated with surgery alone, while 28 patients (20 Stage I and 8 Stage II) received WPI in addition to surgery. With a median follow-up of 75 months (range 25–220 months), a trend toward a decreased rate of pelvic recurrence in those receiving WPI (6/28, 21%) compared to those treated with surgery alone (5/10, 50%) was observed (P= 0.09). There was no difference in the rate of distant recurrence between those receiving WPI (12/28, 43%) and those who did not (4/10, 40%) (P= 0.9). There was also no difference in the 2- and 5-year Kaplan–Meier survival estimates for the patients receiving WPI (79 and 59%, respectively) compared to those who did not receive WPI (60 and 60%, respectively) (P= 0.84). In this small series, the addition of whole-pelvic irradiation to primary surgery did not improve survival; however, a trend toward improved pelvic control was observed, suggesting a possible benefit for pelvic irradiation that should be studied in future trials.