Chemotherapy has been shown to improve survival compared to whole abdominal radiation in the treatment of women with a rare form of uterine cancer-carcinosarcoma of the uterus-who have undergone surgery to remove most of their disease. These results were presented at the 42nd annual meeting of the American Society of Clinical Oncology (ASCO) held in Atlanta, Georgia, June 2-6, 2006.
Optimal adjuvant treatment following initial surgery has not yet been established for the treatment of patients with carcinosarcoma of the uterus who have already undergone surgery to remove as much of the cancer as possible. Approaches including chemotherapy and/or radiation therapy are utilized; however, side effects need to be carefully weighed against the benefits of either approach.
Researchers affiliated with the Gynecologic Oncology Group conducted a randomized clinical trial directly comparing chemotherapy consisting of cisplatin, ifosfamide, and mesna (CIM) to abdominal radiation in the treatment of women with stages I-IV uterine carcinosarcoma. This trial was initiated in 1993, and the 206 patients were followed for 12 years.
After surgery, the patients had no residual disease greater than 1 cm. Patients received their treatment within eight weeks of surgery. The median age was 65 years. The researchers reported the following results:
- Chemotherapy reduced the risk of recurrences by approximately 30%, after adjusting for stage of disease.
- At five years, survival rates were 44% for those treated with chemotherapy, compared with 34% for those treated with whole abdominal radiation.
- At five years, survival rates for patients with stages I-II were 60% for those treated with chemotherapy, compared with only 30% for those treated with whole abdominal radiation.
- Cancer recurrences in the abdominal area were more common among women treated with whole abdominal radiation.
- Cancer recurrences in the vaginal area were more common among women treated with chemotherapy.
The researchers concluded that chemotherapy appears superior to whole abdominal radiation in the treatment of patients with carcinoscarcoma of the uterus who had most of their cancer removed through surgery. Patients with stages I-II appeared to derive the most benefit. Further studies including those using newer chemotherapy drugs, as well as the addition to chemotherapy of radioactive seeds that are implanted in the vagina are ongoing.
Reference: Wolfson A, Brady M, Mannel R, et al. A Gynecologic Oncology Group Randomized Trial of Whole Abdominal Irradiation (WAI) vs Cisplatin-Ifosfamide+Mesna (CIM) in Optimally Debulked Stage I-IV Carcinosarcoma (CS) of the Uterus. Proceedings from the 42nd Annual Meeting of the American Society of Clinical Oncology (ASCO). June 2006. Atlanta, GA. Abstract #5001.