Translate this page into:
Outcomes of carcinosarcoma in a tertiary care institution in India
*Corresponding author: Dr. Anne George Cherian. annegc97@yahoo.co.in
This article was originally published by Thieme Medical and Scientific Publishers Pvt. Ltd. and was migrated to Scientific Scholar after the change of Publisher.
Abstract
Abstract
Background: Carcinosarcoma is a rare malignancy, and reports are often mixed along with other sarcomas. The literature on uterine carcinosarcoma per se is sparse. Aims: This study aims to evaluate the demography, survival, and optimal treatment strategy of uterine carcinosarcoma. Settings and Design: A tertiary care center in India. The study design was descriptive with survival analysis. Materials and Methods: The medical records of all 18 patients admitted with uterine carcinosarcoma between January 2011 and December 2015 were reviewed. Baseline characteristics and outcomes were studied. Survival analysis was done using the Kaplan–Meier method and compared between treatment groups using the Log-rank test. Results: The total number of uterine malignancies operated in our center over this time period was 311 of which 18 were carcinosarcomas (5.7%). Median age of presentation was 61 years (36–77 years). Most women (94%) were postmenopausal and 67% of them presented with postmenopausal bleeding. Over half of the patients (56%) presented late (Stage III or IV). Only 11 (61%) had adjuvant treatment and 7 patients had expired at the time of follow-up. The median survival was 284 days (95% confidence interval 107–461). Patients who received adjuvant therapy did better compared to those who did not (P = 0.036). Conclusions: Carcinosarcomas are aggressive tumors of postmenopausal women who present with bleeding or discharge per vaginum. In spite of adequate surgical staging followed by adjuvant therapy, survival remains poor. Improvements in early detection and optimal therapy need to be made.
Keywords
References
- Brooks SE, Zhan M, Cote T, Baquet CR. Surveillance, epidemiology, and end results analysis of 2677 cases of uterine sarcoma 1989-1999. Gynecol Oncol 2004;93:204-8.
- Schweizer W, Demopoulos R, Beller U, Dubin N. Prognostic factors for malignant mixed müllerian tumors of the uterus. Int J Gynecol Pathol 1990;9:129-36.
- Spanos WJ Jr., Peters LJ, Oswald MJ. Patterns of recurrence in malignant mixed müllerian tumor of the uterus. Cancer 1986;57:155-9.
- Gadducci A, Cosio S, Romanini A, Genazzani AR. The management of patients with uterine sarcoma: A debated clinical challenge. Crit Rev Oncol Hematol 2008;65:129-42.
- Meredith RF, Eisert DR, Kaka Z, Hodgson SE, Johnston GA Jr., Boutselis JG, et al. An excess of uterine sarcomas after pelvic irradiation. Cancer 1986;58:2003-7.
- Amant F, Cadron I, Fuso L, Berteloot P, de Jonge E, Jacomen G, et al. Endometrial carcinosarcomas have a different prognosis and pattern of spread compared to high-risk epithelial endometrial cancer. Gynecol Oncol 2005;98:274-80.
- Wolfson AH, Wolfson DJ, Sittler SY, Breton L, Markoe AM, Schwade JG, et al. Amultivariate analysis of clinicopathologic factors for predicting outcome in uterine sarcomas. Gynecol Oncol 1994;52:56-62.
- Gadducci A, Sartori E, Landoni F, Zola P, Maggino T, Cosio S, et al. The prognostic relevance of histological type in uterine sarcomas: A cooperation task force (CTF) multivariate analysis of 249 cases. Eur J Gynaecol Oncol 2002;23:295-9.
- Gonzalez Bosquet J, Terstriep SA, Cliby WA, Brown-Jones M, Kaur JS, Podratz KC, et al. The impact of multi-modal therapy on survival for uterine carcinosarcomas. Gynecol Oncol 2010;116:419-23.
- Menczer J, Levy T, Piura B, Chetrit A, Altaras M, Meirovitz M, et al. Acomparison between different postoperative treatment modalities of uterine carcinosarcoma. Gynecol Oncol 2005;97:166-70.
- Galaal K, van der Heijden E, Godfrey K, Naik R, Kucukmetin A, Bryant A, et al. Adjuvant radiotherapy and/or chemotherapy after surgery for uterine carcinosarcoma. Cochrane Database Syst Rev 2013;(2):CD006812. doi: 10.1002/14651858.CD006812.pub3.
- Harano K, Hirakawa A, Yunokawa M, Nakamura T, Satoh T, Nishikawa T, et al. Optimal cytoreductive surgery in patients with advanced uterine carcinosarcoma: A multi-institutional retrospective study from the Japanese gynecologic oncology group. Gynecol Oncol 2016;141:447-53.
- Galaal K, Kew FM, Tam KF, Lopes A, Meirovitz M, Naik R, et al. Evaluation of prognostic factors and treatment outcomes in uterine carcinosarcoma. Eur J Obstet Gynecol Reprod Biol 2009;143:88-92.
- Brown LC, Petersen IA, Haddock MG, Bakkum-Gamez JN, Lee LJ, Cimbak NC, et al. Vaginal brachytherapy for early-stage carcinosarcoma of the uterus. Brachytherapy 2015;14:433-9.
- Hosh M, Antar S, Nazzal A, Warda M, Gibreel A, Refky B, et al. Uterine sarcoma: Analysis of 13,089 cases based on surveillance, epidemiology, and end results database. Int J Gynecol Cancer 2016;26:1098-104.
- Omura GA, Major FJ, Blessing JA, Sedlacek TV, Thigpen JT, Creasman WT, et al. Arandomized study of Adriamycin with and without dimethyl triazenoimidazole carboxamide in advanced uterine sarcomas. Cancer 1983;52:626-32.
- Thigpen JT, Brady MF, Homesley HD, Malfetano J, DuBeshter B, Burger RA, et al. Phase III trial of doxorubicin with or without cisplatin in advanced endometrial carcinoma: A gynecologic oncology group study. J Clin Oncol 2004;22:3902-8.
- Curtin JP, Blessing JA, Soper JT, DeGeest K. Paclitaxel in the treatment of carcinosarcoma of the uterus: A gynecologic oncology group study. Gynecol Oncol 2001;83:268-70.
- Sutton G, Brunetto VL, Kilgore L, Soper JT, McGehee R, Olt G, et al. Aphase III trial of ifosfamide with or without cisplatin in carcinosarcoma of the uterus: A Gynecologic Oncology Group study. Gynecol Oncol 2000;79:147-53.
- Anupama R, Kuriakose S, Vijaykumar DK, Pavithran K, Jojo A, Indu RN, et al. Carcinosarcoma of the uterus-a single institution retrospective analysis of the management and outcome and a brief review of literature. Indian J Surg Oncol 2013;4:222-8.