title: Platinum, anthracycline, and alkylating agent-based chemotherapy for ovarian carcinosarcoma.
abstract: BACKGROUND
  Ovarian carcinosarcoma (OCS) is a rare malignancy associated with a poor prognosis. Platinum, anthracyclines, and alkylating agents are the most effective antiblastic drugs for treatment of gynecologic epithelial and stromal tumors. The aim of this study was to determine response rate and overall survival (OS) of patients with OCS who were treated with a combination of these 3 drugs.
  
  
  METHODS
  Forty-one women with OCS who were referred to the Department of Gynecologic Oncology of San Gerardo Hospital in Monza and European Institute of Oncology in Milan, between January 1995, and December 2006, and treated with a combination regimen of cisplatin, adriamycin, and cyclophosphamide or a combination regimen containing of cisplatin, epirubicin, and ifosfamide plus granulocyte colony-stimulating factor were considered for this study.
  
  
  RESULTS
  Four women had OCS stage I; 7, stage II; 23, stage III; and 7, stage IV. Heterologous, homologous, and mixed stromal components were described in 17, 14, and 10 patients, respectively. Thirteen women were treated with a combination of cisplatin, adriamycin, and cyclophosphamide and 28 with a combination of cisplatin, epirubicin, and ifosfamide plus granulocyte colony-stimulating factor. Two women did not complete their treatment because of the rapid progression of their disease and severe toxicity. Among 22 women considered evaluable for response, 10 (46%) achieved a complete response and 3 (13%) achieved a partial response (global response rate, 59%). Overall progression-free survival was 11.8 months (range, 0.9-96 months) and 13.8 and 10.1 months in stage I-II and III-IV, respectively (P = 0.13). Median OS was 20 months (range, 1-123 months), not reached in stage I-II, and 19.7 months in stage III-IV (P = 0.07). No significant difference between homologous and heterologous sarcomatous components was observed (P = 0.95), whereas no significant trend of improved OS was noticed for stage IIIC-IV with optimal debulking surgery (n = 9), compared with suboptimal cytoreduction (n = 19; 32.6 vs 14.5 months, P = 0.14).
  
  
  CONCLUSIONS
  The combination of anthracycline, alkylating agent, and cisplatin showed a good response rate but also a high toxicity. The prognosis of OCS remains poor. Optimal cytoreduction may improve survival, but new anticancer drugs or more effective regimens are awaited.
authors.affiliation: Department of Obstetrics and Gynecology, Gynecologic Oncology Unit, San Gerardo Hospital, University of Milan-Bicocca, Monza, Italy. maurosignorelli@inwind.it
authors.forename: Mauro
authors.initials: M
authors.lastname: Signorelli
authors.forename: Valentina
authors.initials: V
authors.lastname: Chiappa
authors.forename: Lucas
authors.initials: L
authors.lastname: Minig
authors.forename: Robert
authors.initials: R
authors.lastname: Fruscio
authors.forename: Patrizia
authors.initials: P
authors.lastname: Perego
authors.forename: Giovanna
authors.initials: G
authors.lastname: Caspani
authors.forename: Marco
authors.initials: M
authors.lastname: Battistello
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Colombo
mesh_terms: D000368:Aged; D018943:Anthracyclines / Q000008:administration & dosage*; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002296:Carcinosarcoma / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D002945:Cisplatin / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy / Q000379:methods; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D010052:Ovariectomy / Q000379:methods; D017671:Platinum Compounds / Q000008:administration & dosage*; D012189:Retrospective Studies; D012489:Salpingostomy / Q000379:methods; D016019:Survival Analysis
chemical_list: D018943:Anthracyclines; D018906:Antineoplastic Agents, Alkylating; D017671:Platinum Compounds; D002945:Cisplatin