title: Clinical significance of radiotherapy in patients with primary uterine carcinosarcoma: a multicenter retrospective study (KROG 13-08).
abstract: OBJECTIVE
  To investigate the role of radiotherapy (RT) in patients who underwent hysterectomy for uterine carcinosarcoma (UCS).
  
  
  METHODS
  Patients with the International Federation of Gynecology and Obstetrics stage I-IVa UCS who were treated between 1990 and 2012 were identified retrospectively in a multi-institutional database. Of 235 identified patients, 97 (41.3%) received adjuvant RT. Twenty-two patients with a history of previous pelvic RT were analyzed separately. Survival outcomes were assessed using the Kaplan-Meier method and Cox proportional hazards model.
  
  
  RESULTS
  Patients with a previous history of pelvic RT had poor survival outcomes, and 72.6% of these patients experienced locoregional recurrence; however, none received RT after a diagnosis of UCS. Univariate analyses revealed that pelvic lymphadenectomy (PLND) and para-aortic lymph node sampling were significant factors for locoregional recurrence-free survival (LRRFS) and disease-free survival (DFS). Among patients without previous pelvic RT, the percentage of locoregional failure was lower for those who received adjuvant RT than for those who did not (28.5% vs. 17.5%, p=0.107). Multivariate analysis revealed significant correlations between PLND and LRRFS, distant metastasis-free survival, and DFS. In subgroup analyses, RT significantly improved the 5-year LRRFS rate of patients who did not undergo PLND (52.7% vs. 18.7% for non-RT, p<0.001).
  
  
  CONCLUSIONS
  Adjuvant RT decreased the risk of locoregional recurrence after hysterectomy for UCS, particularly in patients without surgical nodal staging. Given the poorer locoregional outcomes of patients previously subjected to pelvic RT, meticulous re-administration of RT might improve locoregional control while leading to less toxicity in these patients.
authors.affiliation: Department of Radiation Oncology, Yonsei University Wonju College of Medicine, Wonju, Korea.
authors.forename: Jihye
authors.identifier: http://orcid.org/0000-0001-5926-5685
authors.initials: J
authors.lastname: Cha
authors.affiliation: Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Young Seok
authors.initials: YS
authors.lastname: Kim
authors.affiliation: Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Won
authors.initials: W
authors.lastname: Park
authors.affiliation: Department of Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Hak Jae
authors.identifier: http://orcid.org/0000-0003-3602-2263
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.
authors.forename: Joo Young
authors.initials: JY
authors.lastname: Kim
authors.affiliation: Department of Radiation Oncology, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.
authors.forename: Jin Hee
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Radiation Oncology, Cheil General Hospital & Women's Healthcare Center, Dankook University College of Medicine, Seoul, Korea.
authors.forename: Juree
authors.identifier: http://orcid.org/0000-0002-3724-5293
authors.initials: J
authors.lastname: Kim
authors.affiliation: Department of Radiation Oncology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea.
authors.forename: Won Sup
authors.identifier: http://orcid.org/0000-0002-6098-1993
authors.initials: WS
authors.lastname: Yoon
authors.affiliation: Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jun Won
authors.identifier: http://orcid.org/0000-0003-1358-364X
authors.initials: JW
authors.lastname: Kim
authors.affiliation: Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea. ybkim3@yuhs.ac.
authors.forename: Yong Bae
authors.identifier: http://orcid.org/0000-0003-4884-2330
authors.initials: YB
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002296:Carcinosarcoma / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D007044:Hysterectomy; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control; D016016:Proportional Hazards Models; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D012189:Retrospective Studies; D015996:Survival Rate; D014594:Uterine Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery
keywords: Locoregional Control; Radiotherapy, Adjuvant; Uterine Carcinosarcoma