The Role of Postoperative Radiotherapy for Carcinosarcoma of the Uterus

Abstract

The role of postoperative radiotherapy delivered as external-beam radiotherapy (EBRT), vaginal brachytherapy (VBT) or a combination of both, in the management of carcinosarcoma of the uterus is not clearly defined, as only limited randomized trial data are available, indicating a reduction in locoregional recurrences after EBRT. We performed a structured review of data published from 2010. Although no relevant new data from prospective trials or meta-analyses were identified, 14 analyses of cancer registry data from the United States or Europe, focusing predominantly on the endpoint for overall survival, were identified, four of them using propensity-score matching to compare subgroups treated with vs. without radiotherapy. Although stage-by-stage data are rare, the registry analyses support the idea of a beneficial effect, especially of VBT, on overall survival in International Federation of Gynecology and Obstetrics (FIGO) stage IA patients (to a lesser extent in stage IB). For stages II to III, the data sets indicate the largest effects on overall survival for the combination of EBRT and VBT. In all stages, survival effects of radiotherapy apparently persist when given in addition to chemotherapy. Whereas some studies see the strongest survival effects in patients with positive lymph nodes, propensity-score matched data indicate an overall survival effect of radiotherapy (EBRT + VBT or VBT alone) in FIGO stages I to III regardless of lymph node surgery.

Primary Cervical Carcinosarcoma: Report of a Rare Case

“…The combination of cisplatin and ifosfamide offers a small improvement in progression-free survival over ifosfamide alone; however, the added toxicity may not justify the use of this combination. 14 …”

“…Whereas some studies see the strongest survival effects in patients with positive lymph nodes; propensity-score matched data indicate an overall survival effect of radiotherapy (EBRT + VBT or VBT alone) in FIGO stages I to III, regardless of lymph node surgery. 14 …”

“…The combination of cisplatin and ifosfamide offers a small improvement in progression-free survival over ifosfamide alone; however, the added toxicity may not justify the use of this combination. 14 With limited data from randomized trials available, the role of postoperative radiotherapy delivered as externalbeam radiotherapy (EBRT), vaginal brachytherapy (VBT), or a combination of both in the management of carcinosarcoma of the uterus is not clearly defined. Findings from a recently published review report that survival effects of radiotherapy apparently persist when given in addition to chemotherapy.…”

“…Whereas some studies see the strongest survival effects in patients with positive lymph nodes; propensity-score matched data indicate an overall survival effect of radiotherapy (EBRT þ VBT or VBT alone) in FIGO stages I to III, regardless of lymph node surgery. 14 Neoadjuvant or preoperative chemotherapy is an alternative treatment option for patients who are not suitable for primary surgical treatment, either due to locoregional advanced disease or due to the patient's status. 15 The role of neoadjuvant chemotherapy has been studied in various types of gynecological malignancy, including ovarian and high-grade endometrial cancers.…”

Comparing paclitaxel-platinum with ifosfamide-platinum as the front-line chemotherapy for patients with advanced-stage uterine carcinosarcoma

“…Radiotherapy, chemotherapy, targeted therapy, and some investigated agents, as well as the combination of any of the above-mentioned therapies (called as multimodality treatment), are believed to provide potentially positive impacts on patients with UCS, and this adjuvant therapy is also apparently beneficial in those with an early UCS. [1][2][3][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] A recent meta-analysis summarizing four studies, which enrolled 2416 patients (939 patients treated with surgery plus postoperative chemotherapy and 1477 patients treated with surgery alone) found that 5-year overall survival (OS) was statistically significantly improved in the combination of surgery and adjuvant chemotherapy group compared to that in the surgery alone group, 23 suggesting that adjuvant chemotherapy should be considered in all UCS patients, regardless of what stages they are. The widely acceptable chemotherapy agents are platinum (either cisplatin or carboplatin), ifosfamide, and paclitaxel.…”