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Khosla D, Patel FD, Kumar R. Sarcomas of the uterine cervix: a united and multidisciplinary approach is required. ACTA ACUST UNITED AC 2013; 9:501-4. [PMID: 24161301 DOI: 10.2217/whe.13.59] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Divya Khosla
- Department of Radiotherapy & Oncology, Regional Cancer Centre, Postgraduate Institute of Medical Education & Research, Sector 12, Chandigarh 160012, India.
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Vasconcelos ALC, Nunes B, Duarte C, Mendonça V, Ribeiro J, Jorge M, Monteiro Grillo I. Tamoxifen in breast cancer ipse dixit in uterine malignant mixed Müllerian tumor and sarcoma-A report of 8 cases and review of the literature. Rep Pract Oncol Radiother 2013; 18:251-60. [PMID: 24416561 DOI: 10.1016/j.rpor.2013.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 05/15/2013] [Accepted: 06/30/2013] [Indexed: 11/17/2022] Open
Abstract
AIM Report the outcome of 8 patients (pts) with breast cancer (BC) treated with Tamoxifen (TAM) that developed malignant mixed Müllerian tumor (MMMT) and rare uterine sarcoma (RUS). PATIENTS AND METHODS Retrospective study based on data collected from the department medical records between April 1999 and September 2010 among 583 pts with endometrial cancer, 36 pts with MMMT and RUS histopathology. Among them, 8 pts underwent TAM between 4 and 10 years due to a previous diagnosis of BC; all pts were post-menopausal with regular gynecological surveillance; 6 pts (75%) with abnormal uterine bleeding. The diagnosis of 6 pts (MMMT) and 2 pts (RUS) occurred at median interval of 8 years (range 4-12) after initial BC treatment. Pts underwent surgical treatment and were staged as stage I (3pts), IIIA (3pts) and IIIC (2 pts) (FIGO 1988); followed by whole pelvis irradiation (50 Gy) and intracavitary HDR brachytherapy boost (24 Gy). Two pts underwent chemotherapy (CT). Overall and disease free survival was calculated by Kaplan Meier method. RESULTS With a median follow-up of 47 months (range 17-130), 3 pts remain alive recurrence-free of BC and RUS. Four pts died with distant metastasis within the first follow-up year, without BC. One pt died from non-related cancer cause. No evidence of local recurrence was found in the whole group of pts. At two years, DFS and OS were 40% and 80%, respectively. CONCLUSION As reported in the literature, TAM administration and causal effect on MMMT and RUS in BC pts is still unknown. No reports about outcome from these specific pts were found.
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Affiliation(s)
- Ana Luisa Cardoso Vasconcelos
- Serviço de Radioterapia Hospital Santa Maria, CHLN, Serviço de Radioterapia do Hospital Santa Maria, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal
| | - Beatriz Nunes
- Serviço de Radioterapia Hospital Santa Maria, CHLN, Serviço de Radioterapia do Hospital Santa Maria, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal
| | - Catarina Duarte
- Serviço de Radioterapia Hospital Santa Maria, CHLN, Serviço de Radioterapia do Hospital Santa Maria, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal
| | - Vera Mendonça
- Serviço de Radioterapia Hospital Santa Maria, CHLN, Serviço de Radioterapia do Hospital Santa Maria, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal
| | - Joana Ribeiro
- Serviço de Oncologia Hospital Santa Maria, CHLN, Serviço de Radioterapia do Hospital Santa Maria, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal
| | - Marília Jorge
- Serviço de Radioterapia Hospital Santa Maria, CHLN, Serviço de Radioterapia do Hospital Santa Maria, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal
| | - Isabel Monteiro Grillo
- Serviço de Radioterapia Hospital Santa Maria, CHLN, Serviço de Radioterapia do Hospital Santa Maria, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal ; Serviço de Oncologia Hospital Santa Maria, CHLN, Serviço de Radioterapia do Hospital Santa Maria, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal ; Instituto de Medicina Molecular, FMUL, Serviço de Radioterapia do Hospital Santa Maria, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal
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Prognostic factors and outcome of undifferentiated endometrial sarcoma treated by multimodal therapy. Int J Gynaecol Obstet 2013; 122:57-61. [PMID: 23597861 DOI: 10.1016/j.ijgo.2013.01.025] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 01/11/2013] [Accepted: 03/08/2013] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To describe the natural history, prognostic factors, and optimal treatment modalities of undifferentiated endometrial sarcoma (UES). METHODS A retrospective review was conducted of 30 patients with UES treated at Institut Gustave-Roussy, France, between January 1978 and December 2008. Clinical and pathologic variables, treatment modalities, and outcomes were assessed. RESULTS Disease was advanced in most cases: FIGO stage III-IV in 70% of patients. Overall, 29 patients (96.7%) underwent hysterectomy as part of the initial surgical treatment; however, only 18 (60.0%) attained complete macroscopic resection. The incidence of pelvic and/or para-aortic lymph-node involvement at primary surgery or first recurrence was 44.4%. Median postoperative follow-up was 5 years; progression-free survival (PFS) and overall survival (OS) were 9.7 and 23 months, respectively. No differences in OS and PFS were observed by staging subgroup (FIGO vs the American Joint Committee on Cancer). Only postoperative pelvic radiotherapy with or without brachytherapy correlated with improved PFS (19.1 vs 6.5 months; P=0.04) and OS (54.5 vs 16.7 months; P=0.01) in a univariate analysis. CONCLUSION Neither staging system was optimal for risk stratification. Multimodal therapy was recommended after surgery.
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Anupama R, Kuriakose S, Vijaykumar DK, Pavithran K, Jojo A, Indu RN, Sheejamol VS. 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. [PMID: 24426726 DOI: 10.1007/s13193-012-0206-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Accepted: 12/18/2012] [Indexed: 11/26/2022] Open
Abstract
Uterine carcinosarcomas are highly aggressive tumors of the uterus associated with a poor prognosis. Though initially classified as sarcomas, now these tumors are classified as carcinomas. The management approach of carcinosarcomas has also changed from those used for high grade sarcomas to that used for managing high grade endometrial carcinomas. The purpose of our study was to analyze the management and outcome of patients with uterine carcinosarcomas treated at our institution and also to attempt a brief review regarding the management of uterine carcinosarcomas. We did a retrospective analysis of all patients with a diagnosis of carcinosarcoma of the uterus treated at our Institution from January 2005 till December 2010. All Patients with a pathological diagnosis of carcinosacrcoma or malignant mixed mullerian tumours of the uterus were included. Data was obtained from the hospital electronic medical records and the hospital cancer registry. Data was analyzed using SPSS v.17. During this 6 year period we had 20 patients with carcinosarcoma of the uterus. 75 % of the patients belonged to Stage I and II. 95 % of the patients underwent Hysterectomy with Bilateral salpingo oophorectomy and 60 % had lymphadenectomy also along with hysterectomy.8 patients had disease recurrence . In patients who had gross extrauterine disease at the time of surgery , the survival was only 9 months whereas in patients who had complete staging with disease confined to the uterus , the survival was 36 months. Carcinosarcomas, accounts for more than 15 % of the uterine cancer associated deaths. Surgery remains the cornerstone of management for these tumors and surgery with pelvic and para aortic lymphadenectomy and peritoneal and omental biopsies is required for the correct staging of the disease and may also provide a survival advantage. Radiation therapy has been shown to provide only better local control without any survival advantage. Further studies are needed to assess whether chemotherapy offers a definite survival benefit in uterine carcinosarcomas.
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Affiliation(s)
- Rajanbabu Anupama
- Department of Surgical Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala India ; Department of Surgical Oncology, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala India 682041
| | | | - D K Vijaykumar
- Department of Surgical Oncology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala India
| | - K Pavithran
- Department of Medical Oncology, Amrita Institute of Medical Sciences, Kochi, Kerala India
| | - Annie Jojo
- Department of Pathology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala India
| | - R Nair Indu
- Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala India
| | - V S Sheejamol
- Department of Biostatistics, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham, Kochi, Kerala India
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Outcome and prognostic factors in endometrial stromal tumors: a Rare Cancer Network study. Int J Radiat Oncol Biol Phys 2012; 82:e757-63. [PMID: 22300565 DOI: 10.1016/j.ijrobp.2011.11.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Revised: 10/30/2011] [Accepted: 11/01/2011] [Indexed: 11/22/2022]
Abstract
PURPOSE To provide further understanding regarding outcome and prognostic factors of endometrial stromal tumors (EST). METHODS AND MATERIALS A retrospective analysis was performed on the records of 59 women diagnosed with EST and treated with curative intent between 1983 and 2007 in the framework of the Rare Cancer Network. RESULTS Endometrial stromal sarcomas (ESS) were found in 44% and undifferentiated ESS (UES) in 49% of the cases. In 7% the grading was unclear. Of the total number of patients, 33 had Stage I, 4 Stage II, 20 Stage III, and 1 presented with Stage IVB disease. Adjuvant chemotherapy was administered to 12 patients, all with UES. External-beam radiotherapy (RT) was administered postoperatively to 48 women. The median follow-up was 41.4 months. The 5-year overall survival (OS) rate was 96.2% and 64.8% for ESS and UES, respectively, with a corresponding 5-year disease-free survival (DFS) rate of 49.4% and 43.4%, respectively. On multivariate analysis, adjuvant RT was an independent prognostic factor for OS (p = 0.007) and DFS (p = 0.013). Locoregional control, DFS, and OS were significantly associated with age (≤60 vs. >60 years), grade (ESS vs. UES), and International Federation of Gynecology and Obstetrics stage (I-II vs. III-IV). Positive lymph node staging had an impact on OS (p < 0.001). CONCLUSION The prognosis of ESS differed from that of UES. Endometrial stromal sarcomas had an excellent 5-year OS, whereas the OS in UES was rather low. However, half of ESS patients had a relapse. For this reason, adjuvant treatment such as RT should be considered even in low-grade tumors. Multicenter randomized studies are still warranted to establish clear guidelines.
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Park HJ, Kim HJ, Wu HG, Kim H, Ha SW, Kang SB, Song YS, Park NH, Kim JW. The influence of adjuvant radiotherapy on patterns of failure and survivals in uterine carcinosarcoma. Radiat Oncol J 2011; 29:228-35. [PMID: 22984675 PMCID: PMC3429907 DOI: 10.3857/roj.2011.29.4.228] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Revised: 08/31/2011] [Accepted: 09/15/2011] [Indexed: 11/03/2022] Open
Abstract
PURPOSE To evaluate the impact of postoperative radiotherapy (PORT) on patterns of failure and survivals in uterine carcinosarcoma patients treated with radical surgery. MATERIALS AND METHODS Between October 1998 and August 2010, 19 patients with stage I-III uterine carcinosarcoma received curative hysterectomy and bilateral salpingo-oophorectomy with or without PORT at Seoul National University Hospital. Their hospital medical records were retrospectively reviewed. PORT and non-PORT groups included 11 and 8 patients, respectively. They were followed for a mean of 22.7 months (range, 7.8 to 126.6 months). RESULTS At 5 years, the overall survival rates were 51.9% for entire, 61.4% for PORT, and 41.7% for non-PORT groups, respectively. There was no statistical difference between PORT and non-PORT groups with regard to overall survival (p = 0.682). Seven out of 19 (36.8%) patients showed treatment failures, which all happened within 12 months. Although the predominant failures were distant metastasis in PORT group and loco-regional recurrence in non-PORT group, there was no statistically significant difference in loco-regional recurrence-free survival (LRRFS) (p = 0.362) or distant metastasis-free survival (DMFS) (p = 0.548). Lymph node metastasis was found to be a significant prognostic factor in predicting poor LRRFS (p = 0.013) and DMFS (p = 0.021), while the International Federation Gynecology and Obstetrics (FIGO) stage (p = 0.043) was associated with LRRFS. CONCLUSION Considering that adjuvant radiotherapy after surgical resection was effective to decrease loco-regional recurrence and most treatment failures were distant metastasis, multimodal therapy including surgery, radiotherapy, and chemotherapy might be an optimal treatment for uterine carcinosarcoma patients.
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Affiliation(s)
- Hae Jin Park
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
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Sampath S, Gaffney DK. Role of radiotherapy treatment of uterine sarcoma. Best Pract Res Clin Obstet Gynaecol 2011; 25:761-72. [DOI: 10.1016/j.bpobgyn.2011.06.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Accepted: 06/19/2011] [Indexed: 10/18/2022]
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Affiliation(s)
- Paolo G Casali
- Adult Mesenchymal Tumour Medical Oncology Unit, Istituto Nazionale Tumori, Milan, Italy
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Seddon BM, Davda R. Uterine sarcomas--recent progress and future challenges. Eur J Radiol 2011; 78:30-40. [PMID: 21247711 DOI: 10.1016/j.ejrad.2010.12.057] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Accepted: 11/30/2010] [Indexed: 10/18/2022]
Abstract
Uterine sarcomas are a group of rare tumours that provide considerable challenges in their treatment. Radiological diagnosis prior to hysterectomy is difficult, with the diagnosis frequently made post-operatively. Current staging systems have been unsatisfactory, although a new FIGO staging system specifically for uterine sarcomas has now been introduced, and may allow better grouping of patients according to expected prognosis. While the mainstay of treatment of early disease is a total abdominal hysterectomy, it is less clear whether routine oophorectomy or lymphadenectomy is necessary. Adjuvant pelvic radiotherapy may improve local tumour control in high risk patients, but is not associated with an overall survival benefit. Similarly there is no good evidence for the routine use of adjuvant chemotherapy. For advanced leiomyosarcoma, newer chemotherapy agents including gemcitabine and docetaxel, and trabectedin, offer some promise, while hormonal therapies appear to be more useful in endometrial stromal sarcoma. Novel targeted agents are now being introduced for sarcomas, and uterine sarcomas, and show some indications of activity. Non-pharmacological treatments, including surgical metastatectomy, radiofrequency ablation, and CyberKnife(®) radiotherapy, are important additions to systemic therapy for advanced metastatic disease.
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Affiliation(s)
- Beatrice M Seddon
- London Sarcoma Service, Department of Oncology, University College Hospital, 1st Floor Central, 250 Euston Road, London, NW1 2PG, United Kingdom.
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Thariat J, Marcy PY. Carcinosarcomas of the uterus should no longer be analyzed with uterine sarcomas. In reply to S. Sampath et al. (Int J Radiat Oncol Biol Phys, 2010;76:728-734). Int J Radiat Oncol Biol Phys 2010; 77:1605. [PMID: 20637984 DOI: 10.1016/j.ijrobp.2010.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Accepted: 04/01/2010] [Indexed: 11/29/2022]
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