title: Vaginal brachytherapy for early-stage carcinosarcoma of the uterus.
abstract: OBJECTIVE
  Uterine carcinosarcoma (CS) is an aggressive malignancy and the optimal adjuvant treatment is not well-established. We report outcomes with vaginal brachytherapy (VB) for women with early-stage CS.
  
  
  METHODS
  A multi-institutional retrospective study of Stage I-II CS treated with hysterectomy, surgical staging, and adjuvant high-dose-rate VB without external-beam pelvic radiotherapy was performed. Rates of vaginal control, pelvic control, locoregional control, disease-free survival, and overall survival were determined using the Kaplan-Meier method.
  
  
  RESULTS
  33 patients were identified. Prescribed VB dose was 21 Gy in three fractions (n = 15 [45%]) or 24 Gy in six fractions (n = 18 [55%]). Eighteen patients (55%) received chemotherapy. Median followup was 2.0 years. Twenty-seven patients (82%) underwent pelvic lymphadenectomy, 5 (15%) had nodal sampling, and 1 (3%) had no lymph node assessment. Relapse occurred in 11 patients (33%), all of whom had lymph node evaluation. Locoregional relapse was a component of failure in 6 patients (18%), of whom 3 (9%) failed in the pelvis alone. Three patients (9%) had simultaneous distant and locoregional relapse (two vaginal, one pelvic). Five additional patients (15%) had distant relapse. Six of the 11 patients (55%) with disease recurrence received chemotherapy. Two-year vaginal control and pelvic control were 94% and 87%. Two-year locoregional control, disease-free survival, and overall survival were 81%, 66%, and 79%.
  
  
  CONCLUSIONS
  Despite having early-stage disease and treatment with VB, patients in this series had relatively high rates of local and distant relapse. Patients who undergo lymphadenectomy and VB remain at risk for relapse. Novel treatment strategies are needed.
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Rochester, MN.
authors.forename: Lindsay C
authors.initials: LC
authors.lastname: Brown
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Rochester, MN.
authors.forename: Ivy A
authors.initials: IA
authors.lastname: Petersen
authors.affiliation: Department of Radiation Oncology, Mayo Clinic, Rochester, MN.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Haddock
authors.affiliation: Department of Gynecologic Oncology, Mayo Clinic, Rochester, MN.
authors.forename: Jamie N
authors.initials: JN
authors.lastname: Bakkum-Gamez
authors.affiliation: Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA.
authors.forename: Larissa J
authors.initials: LJ
authors.lastname: Lee
authors.affiliation: Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA.
authors.forename: Nicole C
authors.initials: NC
authors.lastname: Cimbak
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA.
authors.forename: Ross S
authors.initials: RS
authors.lastname: Berkowitz
authors.affiliation: Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA. Electronic address: aviswanathan@lroc.harvard.edu.
authors.forename: Akila N
authors.initials: AN
authors.lastname: Viswanathan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D002296:Carcinosarcoma / Q000473:pathology / Q000532:radiotherapy* / Q000556:secondary / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007044:Hysterectomy; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D014594:Uterine Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D014621:Vagina
keywords: Carcinosarcoma; Radiation therapy; Uterine cancer