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A population-based series of uterine carcinosarcomas with long-term follow-up
Orebro University Hospital. Dept Oncol.ORCID iD: 0000-0002-5063-631X
Cent Hosp Skovde, Dept Gynecol & Obstet, S-54185 Skovde, Sweden..
Malarsjukhuset, Dept Gynecol & Obstet, Eskilstuna, Sweden..
Univ Gothenburg, Sahlgrenska Univ Hosp, Sahlgrenska Acad, Dept Clin Canc Epidemiol,Inst Clin Sci,Dept Oncol, Gothenburg, Sweden..ORCID iD: 0000-0002-0787-3969
2013 (English)In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 52, no 4, 759-766 p.Article in journal (Refereed) Published
Abstract [en]

Background. Carcinosarcomas are a highly malignant type of endometrial carcinomas where extra uterine spread and recurrences are frequent. There is no consensus regarding the best treatment of this group of malignancies. Material and methods. In a complete geographic series of 322 cases of primary uterine carcinosarcomas prophylactic pelvic irradiation and/or chemotherapy was used as postoperative treatment in the majority of the cases. Vaginal brachytherapy was also added as a boost. The primary surgery was extended hysterectomy in 23 cases (10%), and simple hysterectomy in 220 cases (90%). In 46 cases (14%) no major surgery was possible. Results. In the complete series 123 recurrences (38%) were recorded. Locoregional recurrences (11%) and distant recurrences (28%) were most frequent. Type and extent of surgery was not associated with the risk of tumor recurrence. Extended surgery did not reduce the risk of local and regional recurrences. In the complete series, the five-year overall survival rate was 30% and the recurrence-free survival (RFS) rate was 27%. The five-year pelvic disease control was 82% in stage I, 68% in stage II, and 76% for more advanced stages. The five-year locoregional RFS rate was 63% for patients treated with surgery alone, 68% after addition of adjuvant chemotherapy, 86% after adjuvant radiotherapy, and 95% after combined chemotherapy and radiotherapy. Conclusion. Radiotherapy seems to be the most important constituent of the adjuvant therapy. Serious late tissue reactions, requiring surgery, from the bladder and intestine occurred in 2.5% of the irradiated cases. The death of three patients could be related to radiotherapy and of four patients due to the cytotoxic treatment. This population-based series may serve as a baseline for improvements by, e. g. standard care programs and referral to a few specialist centers for this rare and serious disease.

Place, publisher, year, edition, pages
Informa Healthcare, 2013. Vol. 52, no 4, 759-766 p.
National Category
Cancer and Oncology
Identifiers
URN: urn:nbn:se:oru:diva-56751DOI: 10.3109/0284186X.2012.724179ISI: 000317239200010PubMedID: 23072724OAI: oai:DiVA.org:oru-56751DiVA: diva2:1083986
Available from: 2017-03-23 Created: 2017-03-23 Last updated: 2017-03-23Bibliographically approved

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