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

Abstract

Combination therapy with CT and RT was associated with significantly improved 5-year OS compared with no further therapy, RT alone, or CT alone.

Patterns of adjuvant treatment and survival outcomes in stage I uterine carcinosarcoma

“…This aligns with prior studies using NCDB, which reported 36% − 42% of UCS patients receiving no adjuvant treatment. Notably these NCDB studies included patients of all ages and included either patients from stage I only ( Seagle et al, 2017 ), or stage I-III ( Wong et al, 2017 , Stokes et al, 2018 , Rauh-Hain et al, 2015 ). In our SEER-Medicare population, we found that women who did not receive treatment were generally older, more frequently Black, with higher comorbidity indices, lower income, and resided in the West.…”

“…Highest five-year survival was observed after brachytherapy and multiagent chemotherapy (74.1% (68.3–80.3%), P < 2.0 × 10(–16)). Several other NCDB based studies have reported upon UCS patients in aggregate, including those from stage I-IV ( Rauh-Hain et al, 2015 , Odei et al, 2018 ) or I-III ( Wong et al, 2017 ). Rauh-Jain et al, identified that stage I-II UCS patients receiving combination therapy had significantly improved OS compared to no treatment (HR 0.55, 96 %CI 0.46–0.66, p = not provided), as well as chemotherapy only (HR 0.73, 95% CI 0.60–0.88), whereas radiation alone did not (HR.90, 95% CI 0.80–1.02) ( Rauh-Hain et al, 2015 ).…”

“…Rauh-Jain et al, identified that stage I-II UCS patients receiving combination therapy had significantly improved OS compared to no treatment (HR 0.55, 96 %CI 0.46–0.66, p = not provided), as well as chemotherapy only (HR 0.73, 95% CI 0.60–0.88), whereas radiation alone did not (HR.90, 95% CI 0.80–1.02) ( Rauh-Hain et al, 2015 ). Wong et al identified that combination therapy was associated with improved OS over other subgroups in pairwise analyses, and with improved OS in multivariable adjusted cox-models over no adjuvant therapy (HR, 0.50; 95% CI, 0.44–0.57; P < 0.001) ( Wong et al, 2017 ). Neither of these studies however, reported on stage I UCS outcomes in isolate.…”

Uterine Carcinosarcomas versus Leiomyosarcomas: DuaL Institutional Experience from Mansoura and Zagazig Universities

“…A recent retrospective study from the Netherlands [12], consisting of 1140 cases of CS, proved that adjuvant treatment, whether chemotherapy, radiotherapy or both, improved OS, especially if lymph node dissection was not performed or if the lymph nodes were infiltrated. Wong et al [13] analysed 4906 CS patients and found that the impact of both adjuvant chemotherapy and radiotherapy on OS was greater than the impact of each modality alone and better than no adjuvant at all. Unfortunately, we did not have a sufficient number of patients in the present study to assess the impact of adjuvant treatment on survival.…”

Hypofractionated Accelerated Chemo-radiotherapy (Chemo-HypoAR) With Cisplatin and Liposomal Doxorubicin for the Treatment of Patients With Uterine Sarcomas

“…A biologically equivalent conventionally fractionated radiotherapy scheme (2 Gy/fraction regimen) demands 21 days of therapy (30 days), thus our regimen reduced the overall radiotherapy external beam treatment time by 11 days. The radiobiological methods applied for calculation of the NTD have been previously reported (15,16).…”