Adjuvant radiotherapy and/or chemotherapy after surgery for uterine carcinosarcoma.
BACKGROUND
Uterine carcinosarcomas are uncommon with about 35% not confined to the uterus at diagnosis. The survival of patients with advanced uterine carcinosarcoma is poor with pattern of failure indicating greater likelihood of upper abdominal and distant metastatic recurrence.


OBJECTIVE
To evaluate the effectiveness and safety of radiotherapy and/or systemic chemotherapy in the management of stage III-IV persistent or recurrent uterine carcinosarcoma.


METHODS
We searched the Cochrane Gynaecological Cancer Group Trials Register, CENTRAL, The Cochrane Library 2010, Issue 2, MEDLINE and EMBASE to May 2010. We also searched registers of clinical trials, abstracts of scientific meetings, reference lists of included studies and contacted experts in the field.


METHODS
Randomised controlled trials comparing adjuvant radiotherapy and/or chemotherapy in women with uterine carcinosarcoma.


METHODS
We independently abstracted data and assessed risk of bias. We pooled hazard ratios (HRs) for overall and progression-free survival and risk ratios (RRs) comparing adverse events in women who received radiotherapy and/or chemotherapy in meta-analyses.


RESULTS
Three trials (579 women, of whom all were assessed at the end of the trials) met the inclusion criteria. Two trials (373 women with stage III-IV persistent or recurrent disease) found that women who received combination therapy had a significantly lower risk of death and disease progression than women who received single agent ifosfamide. There was no statistically significant difference in all reported adverse events, with the exception of nausea and vomiting, which affected significantly more women in the combination therapy group than in the ifosamide group.One trial found no statistically significant difference in the risk of death and disease progression in women who received whole abdominal irradiation and chemotherapy, after adjustment for age and FIGO stage (HR = 0.71, 95% CI 0.48 to 1.05 and HR = 0.79, 95% CI 0.53 to 1.18 for overall survival and progression-free survival respectively). There was no statistically significant difference in all reported adverse events, with the exception of haematological and neuropathy morbidities, which affected significantly fewer women in the whole body irradiation group than in the chemotherapy group (RR = 0.02, 95% CI 0.00 to 0.16).


CONCLUSIONS
The results of this review are limited to two trials. In the primary treatment/ first line therapy of advanced stage metastatic uterine carcinosarcoma, as well as in recurrent disease, adjuvant combination chemotherapy with ifosfamide and paclitaxel should be considered. None of the included studies reported on quality of life.
Gynaecological Oncology, Northern Gynaecological Oncology Centre, Queen Elizabeth Hospital, Gateshead, Tyne and Wear, UK, NE9 6SX.
Khadra
K
Galaal
Keith
K
Godfrey
Raj
R
Naik
Ali
A
Kucukmetin
Andrew
A
Bryant
D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use; D002296:Carcinosarcoma / Q000188:drug therapy* / Q000532:radiotherapy* / Q000601:surgery; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D007069:Ifosfamide / Q000627:therapeutic use; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects / Q000379:methods; D016032:Randomized Controlled Trials as Topic; D014594:Uterine Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy* / Q000601:surgery
D018906:Antineoplastic Agents, Alkylating; D007069:Ifosfamide
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