With stage, I to IV uterine carcinosarcoma patients are treated with surgery followed by adjuvant chemotherapy alone, radiation therapy alone, or a combination of chemotherapy and radiation therapy. For a study, researchers sought to assess survival and recurrence pattern variations.
A multicenter retrospective study of patients receiving adjuvant treatment for surgically staged carcinosarcoma from January 2000 to December 2019 was done. Patients having primary surgical treatment for carcinosarcoma and adjuvant chemotherapy, radiation therapy, or a combination of the two were required to meet the inclusion criteria. Patients were disqualified if they had neoadjuvant chemotherapy and/or pre-operative pelvic radiation, received adjuvant brachytherapy alone, received adjuvant chemotherapy and brachytherapy without external beam radiation therapy, or died from an unrelated cause. Using Pearson’s 2 test, the adjuvant treatment modality was used to examine the recurrence sites. Using Kaplan-Meier estimates, progression-free and overall survival were estimated. The Cox proportional hazards model was used for multivariate analysis.
Of the 176 evaluable patients, stage I disease was present in 27% (n=47), stage II in 14% (n=24), stage III in 37% (n=66), and stage IV in 22% (n=39) of the patients. Thirty-three% of them (n=59) underwent chemotherapy alone, 17% (n=29) radiation treatment alone, and 50% (n=88) chemoradiation. In contrast to stage II (83%), stage III (85%), and stage IV (90%) (P< 0.001), patients with stage I illness recurred less frequently (64%). Compared to all other stages, stage I disease showed increased progression-free and overall survival (P<0.01). Patients having chemoradiation had better progression-free (P=0.01) & overall survival (P=0.05) outcomes than those getting single modality treatment across all stages. But when the stage-specific analysis was performed, stage III illness showed the largest survival benefit from chemoradiation compared to all other stages (P<0.01). On multivariate analysis, the only factors that stood out as independent predictors of survival were stage and chemoradiation treatment.
Regardless of the adjuvant therapy approach, stage I illness showed better survival than earlier stages. Chemoradiation has been linked to enhanced local and distant disease control at all disease stages as well as increased survival. Chemoradiation was most beneficial for patients with stage III illness.