Patterns of care, predictors and outcomes of chemotherapy for uterine carcinosarcoma: A National Cancer Database analysis

Survival outcome of women with stage IV uterine carcinosarcoma who received neoadjuvant chemotherapy followed by surgery

“…Uterine carcinosarcoma (UCS) is a rare but aggressive type of high‐grade endometrial cancer, and represents a disease of epithelial‐mesenchymal transition with the sarcoma element arising and dedifferentiated from the carcinoma component . Aggressiveness of UCS is clinically reflected in its stage distribution of tumors: unlike low‐grade endometrial cancer where the majority of tumors present with early stage disease, nearly half of UCS cases are advanced‐stage, including more than 10% with stage IV disease …”

“…However, while primary surgical treatment is generally preferred, patients with stage IV disease are often not suitable surgical candidates for various reasons. These include presence of extensive disease burden and distant parenchymal metastasis, poor performance status, or deconditioning, and extensive medical comorbidity . All of these factors reflect the unique characteristics of UCS; specifically, that UCS is more common in elderly women and often demonstrates wide‐spread tumor progression …”

Use of Adjuvant Chemotherapy, Radiation Therapy, or Combined Modality Therapy and the Impact on Survival for Uterine Carcinosarcoma Limited to the Pelvis

“…A previous analysis of the NCDB also failed to detect any significant impact on survival from the addition of RT (HR, 0.90; 95% CI, 0.80Y1.02) for patients with stage I to IV uterine carcinosarcoma. 15 However, the results of this previous NCDB study are difficult to interpret because, unlike our analysis, it did not exclude patients with metastatic disease or para-aortic nodal involvement, those who did not undergo surgery, and those who may have received RT to sites other than the pelvis. Moreover, the authors did not exclude patients with immediate postoperative mortality, which has been previously demonstrated to impact on the survival analysis of postoperative therapies.…”

Role of Radiation Therapy in the Multidisciplinary Management of Uterine Carcinosarcoma

“…Favorable results with combined modality treatment were also reported in a National Cancer Database study that found that combined modality treatment was associated with improved survival in UC patients. 28 Retrospective and prospective studies, including the Nordic Society of Gynecologic Oncology/European Organization for Research and Treatment of Cancer phase III trial, reported improved outcomes after combined modality treatment. 29 Uterine carcinosarcoma presents with high rates of metastatic disease and a significant risk of hematologic and lymphatic spread even with treatment.…”