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Improved survival with combination chemotherapy and external beam radiation therapy in uterine carcinosarcoma
  1. Jennifer McEachron1,
  2. Yi-Ju Chen2,
  3. Nancy Zhou2,
  4. Johnny Kao3,
  5. Constantine Gorelick4,
  6. Marguax J Kanis4 and
  7. Yi-Chun Lee1
  1. 1Gynecologic Oncology, Catholic Health Services of Long Island, Rockville Centre, New York, USA
  2. 2Gynecologic Oncology, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
  3. 3Radiation Oncology, Good Samaritan Hospital Medical Center, West Islip, New York, USA
  4. 4Gynecologic Oncology, New York Presbyterian – Brooklyn Methodist Hospital, Brooklyn, New York, USA
  1. Correspondence to Dr Jennifer McEachron, Division of Gynecologic Oncology, The Cancer Institute at Good Samaritan Hospital Medical Center, Rockville Centre, NY NY 11795, USA; jennifer.mceachron{at}gmail.com

Abstract

Objectives To evaluate differences in survival and recurrence patterns in stage I–IV uterine carcinosarcoma patients treated with surgery followed by adjuvant chemotherapy alone, radiation alone, or a combination of both chemotherapy and radiation therapy.

Methods A multicenter retrospective analysis of patients with surgically staged carcinosarcoma receiving adjuvant therapy from January 2000 to December 2019 was conducted. Inclusion criteria were patients with carcinosarcoma who had received primary surgical treatment, followed by adjuvant therapy with chemotherapy alone, radiation therapy alone, or a combination of chemoradiation. Patients were excluded for incomplete surgical staging data, adjuvant brachytherapy alone, adjuvant chemotherapy and brachytherapy without external beam radiation therapy, receipt of neoadjuvant chemotherapy and/or pre-operative pelvic radiation, and death due to non-cancer causes. Sites of recurrence were analyzed by adjuvant treatment modality using Pearson’s χ2 test. Progression-free and overall survival were calculated using Kaplan-Meier estimates. Multivariate analysis was performed using Cox proportional hazards model.

Results Of 176 evaluable patients, 27% (n=47) had stage I, 14% (n=24) stage II, 37% (n=66) stage III, and 22% (n=39) stage IV disease. Among them, 33% (n=59) received chemotherapy alone, 17% (n=29) received radiation therapy alone, and 50% (n=88) received chemoradiation. Patients with stage I disease recurred less frequently (64%) versus stage II (83%), stage III (85%), and stage IV (90%) (p<0.001). Stage I disease demonstrated improved progression-free and overall survival relative to all other stages (p<0.01). Across all stages, patients receiving chemoradiation experienced superior progression-free (p=0.01) and overall survival (p=0.05) versus single modality therapy. However, when analyzed in a stage-specific manor, stage III disease derived the greatest survival benefit from chemoradiation versus all other stages (p<0.01). On multivariant analysis, only stage and receipt of chemoradiation were independent predictors of survival.

Conclusion Stage I disease demonstrated improved survival compared with other stages regardless of adjuvant treatment modality. Chemoradiation was associated with improved survival and better distant and local disease control for all stages of disease. Patients with stage III disease derived the most benefit from chemoradiation.

  • Carcinosarcoma
  • Radiation

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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Footnotes

  • Contributors JM: conceptualization, methodology, formal analysis, writing – original draft, guarantor; YJC: data curation; NZ: data curation; JK: writing – review and editing; CG: writing – review and editing; MJK: conceptualization, writing – review and editing; YCL: methodology, writing – review and editing, supervision, project administration.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.