title: Outcome and Predictive Factors in Uterine Carcinosarcoma Using Postoperative Radiotherapy: A Rare Cancer Network Study.
abstract: Uterine carcinosarcomas (UCS) are rare tumors. Consensus regarding therapeutic management in non-metastatic disease is lacking. This study reports on outcome and predictive factors when using postoperative radiotherapy. We analyzed a retrospective analysis in 124 women treated between 1987-2007 in the framework of the Rare-Cancer-Network. Median follow-up was 27 months. Postoperative pelvic EBRT was administered in 105 women (85%) and 92 patients (74%) received exclusive or additional vaginal brachytherapy. Five-year overall survival (OS), disease-free survival (DFS), cancer specific survival (CSS) and locoregional control (LRC) were 51.6% (95% CI 35-73%), 53.7% (39-71%), 58.6% (38-74%) and 48% (38-67%). Multivariate analysis showed that external beam radiation therapy (EBRT) >50Gy was an independent prognostic factor for better OS (P=0.03), CSS (P=0.02) and LRC (P=0.01). Relative risks (RR) for better OS (P=0.02), DFS (P=0.04) and LRC (P=0.01) were significantly associated with younger age (≤60 years). Higher brachytherapy (BT)-dose (>9Gy) improved DFS (P=0.04) and LRC (P=0.008). We concluded that UCS has high systemic failure rate. Local relapse was reduced by a relative risk factor of over three in all stages of diseases when using higher doses for EBRT and brachytherapy. Postoperative RT was most effective in UCS stage I/II-diseases.
authors.affiliation: Department of Radiation Oncology, Kantonsspital Graubuenden, Chur, Switzerland; Department of Radiation Oncology, William Buckland Radiotherapy Centre, Alfred Health, Melbourne, Australia.
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Zwahlen
authors.affiliation: Department of Radiation Oncology, University Hospital Geneva , Switzerland.
authors.forename: Ulrike
authors.initials: U
authors.lastname: Schick
authors.affiliation: Department of Radiation Oncology, Ege University Hospital , Izmir, Turkey.
authors.forename: Yasemin
authors.initials: Y
authors.lastname: Bolukbasi
authors.affiliation: Department of Radiation Oncology, Antoine Lacassagne Center , Nice, France.
authors.forename: Juliette
authors.initials: J
authors.lastname: Thariat
authors.affiliation: Department of Radiation Oncology, Rambam Medical Center , Haifa, Israel.
authors.forename: Roxolyana
authors.initials: R
authors.lastname: Abdah-Bortnyak
authors.affiliation: Department of Radiation Oncology, Rambam Medical Center , Haifa, Israel.
authors.forename: Abraham
authors.initials: A
authors.lastname: Kuten
authors.affiliation: Department of Radiation Oncology, Metropolitan Hospital , Istanbul, Turkey.
authors.forename: Sefik
authors.initials: S
authors.lastname: Igdem
authors.affiliation: Department of Radiation Oncology, Marmara University Hospital , Istanbul, Turkey.
authors.forename: Hale
authors.initials: H
authors.lastname: Caglar
authors.affiliation: Department of Radiation Oncology, Ege University Hospital , Izmir, Turkey.
authors.forename: Zeynep
authors.initials: Z
authors.lastname: Ozsaran
authors.affiliation: Department of Radiation Oncology, University Hospital , Bern, Switzerland.
authors.forename: Kristina
authors.initials: K
authors.lastname: Loessl
authors.affiliation: Department of Radiation Oncology, Hôpital du Valais , Sion, Switzerland.
authors.forename: Kaouthar Khanfir
authors.initials: KK
authors.lastname: Belkaaloul
authors.affiliation: Department of Radiation Oncology, René Huguenin Center , Saint-Cloud, France.
authors.forename: Sylviane
authors.initials: S
authors.lastname: Villette
authors.affiliation: Department of Radiation Oncology, University Hospital Geneva , Switzerland.
authors.forename: Hansjörg
authors.initials: H
authors.lastname: Vees
keywords: Carcinosarcoma; brachytherapy; radiotherapy; toxicity; uterine malignancies