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Role of Radiation Therapy in the Multidisciplinary Management of Uterine Carcinosarcoma
  1. Jillian R. Gunther, MD, PhD*,
  2. Eva N. Christensen, MD, PhD*,,
  3. Pamela K. Allen, PhD*,
  4. Lois M. Ramondetta, MD,
  5. Anuja Jhingran, MD*,
  6. Nicole D. Fleming, MD,
  7. Elizabeth D. Euscher, MD§,
  8. Karen H. Lu, MD,
  9. Patricia J. Eifel, MD* and
  10. Ann H. Klopp, MD, PhD*
  1. * Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston;
  2. Green Bay Oncology, Green Bay, WI; Departments of
  3. Gynecologic Oncology and Reproductive Medicine, and
  4. § Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX.
  1. Address correspondence and reprint requests to Ann Klopp, MD, PhD, Pickens Academic Tower, 1515 Holcombe Blvd, Unit 1422, Houston, TX 77030. E-mail: AKlopp{at}mdanderson.org.

Abstract

Objectives This study aimed to evaluate the impact of radiation therapy on outcomes for patients with uterine carcinosarcoma (UC).

Methods/Materials We retrospectively reviewed the records of 155 women with stage I (98), II (11), or III (46) UC who underwent total abdominal hysterectomy/bilateral salpingo-oophorectomy at our institution between 1990 and 2011. Survival rates were assessed using the Kaplan-Meier method and log-rank test. Univariate and multivariate Cox regression analyses were performed.

Results Seventy-six patients (49%) received radiation therapy: 38 (50%) had vaginal cuff brachytherapy (VBT) alone and 38 had external beam radiation therapy (EBRT) ± VBT. Seventy patients (45%) received chemotherapy (12 concurrent, 49 adjuvant, 9 both). The 5-year overall survival rate was 48.6% (stage I, 53.8%; II, 30.0%; and III, 42.5%). The disease-specific survival (DSS) rate was 57.2% (stage I, 60.9%; II, 44.4%; and III, 51.8%). Patients treated with EBRT had a higher 5-year pelvic disease control rate (88.3%) than did patients treated with VBT only (67.4%) or no radiation (71.2%; P = 0.04). In stage III patients, EBRT was associated with higher 5-year pelvic disease control (90.0% vs 55.5%, P = 0.046), DSS (64.6% vs 46.4%, P = 0.13), and overall survival (64.6% vs 34.0%, P = 0.04) rates. For all 155 patients, age at least 65 years, cervical involvement, and lymph vascular space invasion were correlated with lower DSS on univariate and multivariate analyses. In addition, treatment with concurrent chemoradiation therapy was independently associated with a higher DSS rate on multivariate analysis.

Conclusions Patients with UC have a high rate of relapse in the regional nodes and distant sites. External beam radiation therapy improves locoregional control in all stages and may improve survival in stage III patients who are at the highest risk of pelvic relapse.

  • Uterine carcinosarcoma
  • Radiation therapy
  • Uterine malignant mixed müllerian tumor

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Footnotes

  • The authors declare no conflicts of interest.

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