(P009) Early-Stage Carcinosarcoma Treated With Adjuvant Radiotherapy and Chemotherapy

Neil B. Desai, MD, Marisa A. Kollmeier, MD, Vicky Makker, MD, Nadeem R. Abu-Rustum, MD, Richard R. Barakat, MD, Kaled M. Alektiar, MD; Memorial Sloan-Kettering Cancer Center

Purpose and Objectives: To report a single-institution experience using adjuvant chemoradiation for early-stage carcinosarcoma (CS) of the uterus.

Materials and Methods: We retrospectively reviewed 31 women with completely resected stage I–II CS following hysterectomy/bilateral salpingo-oophorectomy (BSO) who received adjuvant radiotherapy (RT) and chemotherapy from 2000–2010. Exclusions were lack of residual disease after diagnostic biopsy, positive washings, or prior abdominopelvic malignancy.

Results: Of the 31 patients, 24 (77%) were stage IA, 4 (13%) were IB, and 3 (10%) were stage II. Pelvic node sampling was performed in 97% of patients (median, 17 nodes), and para-aortic node sampling was performed in 81% (median, 6 nodes). None of the patients had positive pelvic cytology. The chemotherapy regimen was carboplatin/taxane in 26 patients (84%), ifosfamide-based doublet in 3 patients (10%), or carboplatin alone in 2 patients (6%). Adjuvant RT was primarily given as intravascular RT (IVRT) in 30/31 patients (97%) to a median dose of 21 Gy, and only 1 patient (3%) received pelvic RT. Median follow-up was 48 months. The 5-year actuarial rate of pelvic recurrence was 11% (95% confidence interval [CI], 0%–23%) and 11% for para-aortic recurrence (95% CI, 0%–22%). There were no vaginal recurrences, and the 5-year rate of isolated pelvic recurrence was 3.7% (95% CI, 0%–10%). The 5-year actuarial rate of peritoneal relapse was 11% (95% CI, 0%–22%) and 26% for other distant metastases (95% CI, 10%–42%). The 5-year disease-free survival (DFS) was 66% (95% CI, 50%–82%), and the 5-year overall survival (OS) was 79% (95% CI, 61%–96%).

Conclusions: Adjuvant chemotherapy coupled with intravaginal RT (given to 30/31 patients) seems to provide a good outcome in terms of low rate of isolated pelvic recurrence (3.7%). However, given the rate of distant metastasis, further intensification of systemic therapy is still needed in this group of patients.