Adjuvant pelvic radiotherapy for uterine carcinosarcoma in a high risk population.

OBJECTIVES: The purpose of this study was to examine the clinical outcomes of patients with uterine carcinosarcoma and to review the role of adjuvant pelvic radiotherapy in the management of patients with high pathologic risk factors for recurrences.
METHODS: A retrospective review was carried out at the Saskatoon Cancer Agency. All patients with a diagnosis of uterine carcinosarcoma from 1990-1995 were identified. Clinical and pathologic data were analysed in a computerized database. Kaplan-Meier survival estimates were computed. Log-rank test was used to compare survival curves and disease-free survival estimates.
RESULTS: Thirty-two patients are reported. The median age at presentation was 71. Most patients presented with abnormal postmenopausal bleeding. Eighty-four percent of patients had disease confined to the uterus at the time of evaluation. Patients with high-grade (2, 3) adenocarcinoma, deep myometrial invasion, or gross pelvic metastatic disease were offered adjuvant pelvic irradiation. The overall 5-year survival for the whole group is 38%. There is no statistically significant difference in the progression-free or overall survival in the radiated group compared to the expectantly treated group.
CONCLUSION: Uterine carcinosarcoma is a rare and aggressive form of uterine malignancy even in early stages. Adjuvant pelvic radiotherapy seems to improve the progression-free survival and overall survival in patients with poor histologic prognostic factors. The role of chemotherapy deserves further investigation as all recurrences were in the upper abdominal and distant locations outside of the radiation field. PRECIS: Uterine sarcoma has a poor prognosis even in early stage. Adjuvant pelvic radiotherapy seems to improve the outcomes of patients with adverse histologic risk factors. Copyright Harcourt Publishers Limited.