A comparison between different postoperative treatment modalities of uterine carcinosarcoma.
OBJECTIVE
Uterine carcinosarcomas are highly aggressive neoplasms with no established effective adjuvant therapy. The aim of the present study was to compare between the outcome in three medical institutions in each of which a different postoperative treatment modality was preferred, namely, chemotherapy in one, whole pelvic irradiation (WPI) in another, and sequential treatment (i.e., chemotherapy followed by WPI) in the third.


METHODS
The hospital records of all 49 uterine carcinosarcoma patients diagnosed and operated from 1995 to 2003 in the three institutions were reviewed. Non-parametric test was used to compare the median age between the treatment groups. Survival was calculated using the Kaplan-Meier method and compared by the log-rank test. Cox proportional hazard regression model was used to assess the effect of treatment type on survival after adjustment for stage.


RESULTS
Only about half of the patients (51%) had stage I at diagnosis and the majority of the patients (83.7%) had postoperative adjuvant treatment. The overall 5-year survival of the 41 patients that had postoperative treatment was 49.6%. The highest median survival and 5-year survival rate was observed in the sequential treatment group. Controlling for stage, this treatment modality was associated with a significant decrease in mortality of about 80% when compared to postoperative chemotherapy alone, and a non-significant decrease in mortality of about 50% when compared to WPI alone (HR = 0.20; 95% CI 0.04-0.99, P = 0.049 and HR = 0.50; 95% CI 0.1-2.32, P = 0.4, respectively).


CONCLUSIONS
The improved outcome in patients who received postoperative sequential treatment seems to indicate that further exploration of this treatment modality is justified.
Menczer
Joseph
J
Departments of Obstetrics and Gynecology, Gynecologic Oncology Units, E.Wolfson Medical Center, Holon, Israel. joseph12@internet-zahav.net
Levy
Tally
T
Piura
Benjamin
B
Chetrit
Angela
A
Altaras
Marco
M
Meirovitz
Mihai
M
Glezerman
Marek
M
Fishman
Ami
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002296:Carcinosarcoma / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008875:Middle Aged; D018714:Radiotherapy, Adjuvant; D015996:Survival Rate; D014594:Uterine Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery / Q000628:therapy*