Outcome and predictive factors in uterine carcinosarcoma using postoperative radiotherapy: a Rare Cancer Network study
Daniel R. Zwahlen,
Ulrike Schick,
Yasemin Bolukbasi,
Juliette Thariat,
Roxolyana Abdah-Bortnyak,
Abraham Kuten,
Sefik Igdem,
Hale Caglar,
Zeynep Ozsaran,
Kristina Loessl,
Kaouthar Khanfir Belkaaloul,
Sylviane Villette,
Hansjörg Vees
Affiliations
Daniel R. Zwahlen
Department of Radiation Oncology, Kantonsspital Graubuenden, Chur, Switzerland; Department of Radiation Oncology, William Buckland Radiotherapy Centre, Alfred Health, Melbourne
Ulrike Schick
Department of Radiation Oncology, University Hospital Geneva
Yasemin Bolukbasi
Department of Radiation Oncology, Ege University Hospital, Izmir
Juliette Thariat
Department of Radiation Oncology, Antoine Lacassagne Center, Nice
Roxolyana Abdah-Bortnyak
Department of Radiation Oncology, Rambam Medical Center, Haifa
Abraham Kuten
Department of Radiation Oncology, Rambam Medical Center, Haifa
Sefik Igdem
Department of Radiation Oncology, Metropolitan Hospital, Istanbul
Hale Caglar
Department of Radiation Oncology, Marmara University Hospital, Istanbul
Zeynep Ozsaran
Department of Radiation Oncology, Ege University Hospital, Izmir
Kristina Loessl
Department of Radiation Oncology, University Hospital, Bern
Kaouthar Khanfir Belkaaloul
Department of Radiation Oncology, Hôpital du Valais, Sion
Sylviane Villette
Department of Radiation Oncology, René Huguenin Center, Saint-Cloud
Hansjörg Vees
Department of Radiation Oncology, University Hospital, Geneva
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.
