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 (

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D’Angelo E, Prat J. Uterine sarcomas: a review. Gynecol Oncol 2010;116:131-9.
Leath CA, Numnum TM, Kendrick JE, Frederick PJ, Rocconi RP, Conner MG, et al. Patterns of failure for conservatively managed surgical stage I uterine carcinosarcoma: implications for adjuvant therapy. Int J Gynecol Cancer 2009;19:888-91.
Gokce ZK, Turan T, Karalok A, Tasci T, Ureyen I, Ozkaya E, et al. Clinical outcomes of uterine carcinosarcoma: results of 94 patients. Int J Gynecol Cancer 2015;25:279-87.
Curtin JP, Blessing JA, Soper JT, DeGeest K. Paclitaxel in the treatment of carcinosarcoma of the uterus: a gynecologic oncology group study. Gynecol Oncol 2001;83:268-70.
Odei B, Boothe D, Suneja G, Werner TL, Gaffney DK. Chemoradiation Versus Chemotherapy in Uterine Carcinosarcoma: Patterns of Care and Impact on Overall Survival. Am J Clin Oncol 2018;41:784-91.
Rauh-Hain JA, Starbuck KD, Meyer LA, Clemmer J, Schorge JO, Lu KH, et al. Patterns of care, predictors and outcomes of chemotherapy for uterine carcinosarcoma: A National Cancer Database analysis. Gynecol Oncol 2015;139:84-9.
Matsuo K, Omatsu K, Ross MS, Johnson MS, Yunokawa M, Klobocista MM, et al. Impact of adjuvant therapy on recurrence patterns in stage I uterine carcinosarcoma. Gynecol Oncol 2017;145:78-87. Seagle BL, Kanis M, Kocherginsky M, Strauss JB, Shahabi S. Stage I uterine carcinosarcoma: Matched cohort analyses for lymphadenectomy, chemotherapy, and brachytherapy. Gynecol Oncol 2017;145:71-7.
Cantrell LA, Havrilesky L, Moore DT, O'Malley D, Liotta M, Secord AA, et al. A multi-institutional cohort study of adjuvant therapy in stage I-II uterine carcinosarcoma. Gynecol Oncol 2012;127:22-6.
Garg G, Yee C, Schwartz KL, Mutch DG, Morris RT, Powell MA. Patterns of care, predictors, and outcomes of chemotherapy in elderly women with early-stage uterine carcinosarcoma: a population-based analysis. Gynecol Oncol 2014;133:242-9.
Reed NS, Mangioni C, Malmström H, Scarfone G, Poveda A, Pecorelli S, et al. 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 2008;44:808-18.
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.
Guttmann DM, Li H, Sevak P, Grover S, Jacobson G, Feldman A, et al. The Impact of Adjuvant Therapy on Survival and Recurrence Patterns in Women With Early-Stage Uterine Carcinosarcoma: A Multi-institutional Study. Int J Gynecol Cancer 2016;26:141-8.
Manolitsas TP, Wain GV, Williams KE, Freidlander M, Hacker NF. Multimodality therapy for patients with clinical Stage I and II malignant mixed Müllerian tumors of the uterus. Cancer 2001;91:1437-43.
Wolfson AH, Brady MF, Rocereto T, Mannel RS, Lee YC, Futoran RJ, 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.
Sutton G, Kauderer J, Carson LF, Lentz SS, Whitney CW, Gallion H, 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 2005;96:630-4.
Temkin SM, Hellmann M, Lee YC, Abulafia O. Early-stage carcinosarcoma of the uterus: the significance of lymph nodecount. Int J Gynecol Cancer 2007;17:215-9.
Vorgias G, Fotiou S. The role of lymphadenectomy in uterine carcinosarcomas (malignant mixed mullerian tumours): a critical literature review. Arch Gynecol Obstet 2010;282:659-64.
Koh WJ, Greer BE, Abu-Rustum NR, Apte SM, Campos SM, Cho KR, et al. Uterine Sarcoma, Version 1.2016: Featured Updates to the NCCN Guidelines. J Natl Compr Canc Netw 2015;13:1321-31.
Park JY, Kim DY, Kim JH, Kim YM, Kim YT, Nam JH. The role of pelvic and/or para-aortic lymphadenectomy in surgical management of apparently early carcinosarcoma of uterus. Ann Surg Oncol 2010;17:861-8.
Sutton G, Brunetto VL, Kilgore L, Soper JT, McGehee R, Olt G, 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.
Ramondetta LM, Burke TW, Jhingran A, Schmandt R, Bevers MW, Wolf JK, et al. A phase II trial of cisplatin, ifosfamide, and mesna in patients with advanced or recurrent uterine malignant mixed müllerian tumors with evaluation of potential molecular targets. Gynecol Oncol 2003;90:529-36.
Lacour RA, Euscher E, Atkinson EN, Sun CC, Ramirez PT, Coleman RL, et al. A phase II trial of paclitaxel and carboplatin in women with advanced or recurrent uterine carcinosarcoma. Int J Gynecol Cancer 2011;21:517-22.
Otsuki A, Watanabe Y, Nomura H, Futagami M, Yokoyama Y, Shibata K, et al. Paclitaxel and carboplatin in patients with completely or optimally resected carcinosarcoma of the uterus: a phase II trial by the Japanese Uterine Sarcoma Group and the Tohoku Gynecologic Cancer Unit. Int J Gynecol Cancer 2015;25:92-7.
Powell MA, Filiaci VL, Rose PG, Mannel RS, Hanjani P, Degeest K, 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.
Toyoshima M, Akahira J, Matsunaga G, Niikura H, Ito K, Yaegashi N, et al. Clinical experience with combination paclitaxel and carboplatin therapy for advanced or recurrent carcinosarcoma of the uterus. Gynecol Oncol 2004;94:774-8.