%0 Journal Article
%T Uterine Carcinosarcoma Confined to the Pelvis: A Retrospective Review and Outcome Analysis
%A Hualei Li
%A Mindi J. TenNapel
%A Amina Ahmed
%A Lilie Lin
%A Sudershan K. Bhatia
%A Geraldine Jacobson
%J Journal of Radiotherapy
%D 2014
%R 10.1155/2014/124149
%X Objective. We compared the treatments of uterine carcinosarcoma at our institution and evaluated their impact on survival. Methods. A retrospective analysis was performed on 60 eligible patients with carcinosarcoma limited to the pelvis. Subjects were divided into four categories: surgery, surgery plus chemotherapy, surgery plus radiation therapy, and a combination of surgery, chemotherapy, and RT. The most commonly used chemotherapy was cisplatin and/or carboplatin and taxol. Radiotherapy included external beam radiation therapy (EBRT) alone or with high dose rate (HDR) brachytherapy or HDR brachytherapy alone. Survival probability data were computed using the Kaplan-Meier method. The differences between groups were compared using the log-rank test. Results. The combination of surgery and radiation therapy with or without chemotherapy is seen to improve overall survival (OS) compared to surgery alone and , resp.). Brachytherapy involving three HDR vaginal cylinder fractions shows an equally effective reduction in local recurrence compared to EBRT. Conclusion. Our study of a relatively large number of carcinosarcoma patients suggests that adjuvant radiation therapy improves OS compared to surgery alone. Brachytherapy with 3 HDR vaginal cylinder fractions is preferred because of its time-saving, better tolerance, low toxicity and equivalent OS, and local control compared to EBRT. 1. Introduction Carcinosarcoma is a rare malignant tumor composed of both epithelial (carcinomatous) and mesenchymal (sarcomatous) components [1]. In Western populations, uterine carcinosarcomas account for less than 5% of all cancers of the uterine corpus [2]. It usually occurs in postmenopausal women more than 60 years old [3]. Approximately 35% of carcinosarcoma patients present with advanced-stage disease at diagnosis. The five-year overall survival rate for all stages is 33¨C39% due to the high propensity for both local and distant relapse [4¨C6]. For patients with stage I disease, overall 5-year survival is approximately 50%, and for patients with advanced-stage disease, 5-year overall survival is less than 25% [7]. Cancer stage, particularly, depth of myometrial invasion, is the most important prognostic factor in carcinosarcoma [7, 8]. Although surgery is the primary treatment, several retrospective studies were performed to determine which adjuvant therapy is best: chemotherapy and/or radiotherapy [3]. Due to high local and distant recurrence rates, radiotherapy and chemotherapy have been used to increase the probability of local or distant control and several studies
%U http://www.hindawi.com/journals/jra/2014/124149/