Differences in overall survival associated with type and sequence of adjuvant therapy in stage I uterine carcinosarcoma

Purpose To compare overall survival between patients who received neoadjuvant therapy (NAT) followed by resection and those who received upfront resection (UR)—as well as a subgroup of UR patients who also received adjuvant therapy—for early-stage resectable pancreatic adenocarcinoma. Patients and Methods Adult patients with resected, clinical stage I or II adenocarcinoma of the head of the pancreas were identified in the National Cancer Database from 2006 to 2012. Patients who underwent NAT followed by curative-intent resection were matched by propensity score with patients whose tumors were resected upfront. Overall survival was compared by using a Cox proportional hazards regression model. Early postoperative and oncologic outcomes were evaluated. Results We identified 15,237 patients with clinical stage I or II resected pancreatic head adenocarcinoma. From the NAT group, 2,005 patients (95%) were matched with 6,015 patients who underwent UR. The NAT group was associated with improved survival compared with UR (median survival, 26 months v 21 months, respectively; stratified log-rank P < .01; hazard ratio, 0.72; 95% CI, 0.68 to 0.78). Patients in the UR group had higher pathologic T stage (pT3 and T4: 86% v 73%; P < .01), higher positive lymph nodes (73% v 48%; P < .01), and higher positive resection margin (24% v 17%; P < .01). Compared with a subset of UR patients who received adjuvant therapy, NAT patients had a better survival (adjusted hazard ratio, 0.83; 95% CI, 0.73 to 0.89). Conclusion NAT followed by resection has a significant survival benefit compared with UR in early-stage, resected pancreatic head adenocarcinoma. These findings support the use of NAT, particularly as a patient selection tool, in the management of resectable pancreatic adenocarcinoma.

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EPV239/#263 Evaluation of the impact of postoperative adjuvant therapy on survival and recurrence patterns in stage I-IV uterine carcinosarcoma

10.1136/ijgc-2021-igcs.310 ◽

2021 ◽

Author(s):

J Mceachron ◽

Y-J Chen ◽

N Zhou ◽

C Gorelick ◽

M Kanis ◽

...

Keyword(s):

Adjuvant Therapy ◽

Stage I ◽

Postoperative Adjuvant Therapy ◽

Uterine Carcinosarcoma ◽

Recurrence Patterns ◽

The Impact

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Role of Radiation Therapy in the Multidisciplinary Management of Uterine Carcinosarcoma

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000001135 ◽

2018 ◽

Vol 28 (1) ◽

pp. 114-121 ◽

Cited By ~ 3

Author(s):

Jillian R. Gunther ◽

Eva N. Christensen ◽

Pamela K. Allen ◽

Lois M. Ramondetta ◽

Anuja Jhingran ◽

...

Keyword(s):

Overall Survival ◽

Radiation Therapy ◽

Disease Control ◽

External Beam Radiation Therapy ◽

Stage I ◽

Stage Iii ◽

External Beam Radiation ◽

External Beam ◽

Uterine Carcinosarcoma ◽

Beam Radiation

ObjectivesThis study aimed to evaluate the impact of radiation therapy on outcomes for patients with uterine carcinosarcoma (UC).Methods/MaterialsWe retrospectively reviewed the records of 155 women with stage I (98), II (11), or III (46) UC who underwent total abdominal hysterectomy/bilateral salpingo-oophorectomy at our institution between 1990 and 2011. Survival rates were assessed using the Kaplan-Meier method and log-rank test. Univariate and multivariate Cox regression analyses were performed.ResultsSeventy-six patients (49%) received radiation therapy: 38 (50%) had vaginal cuff brachytherapy (VBT) alone and 38 had external beam radiation therapy (EBRT) ± VBT. Seventy patients (45%) received chemotherapy (12 concurrent, 49 adjuvant, 9 both). The 5-year overall survival rate was 48.6% (stage I, 53.8%; II, 30.0%; and III, 42.5%). The disease-specific survival (DSS) rate was 57.2% (stage I, 60.9%; II, 44.4%; and III, 51.8%). Patients treated with EBRT had a higher 5-year pelvic disease control rate (88.3%) than did patients treated with VBT only (67.4%) or no radiation (71.2%; P = 0.04). In stage III patients, EBRT was associated with higher 5-year pelvic disease control (90.0% vs 55.5%, P = 0.046), DSS (64.6% vs 46.4%, P = 0.13), and overall survival (64.6% vs 34.0%, P = 0.04) rates. For all 155 patients, age at least 65 years, cervical involvement, and lymph vascular space invasion were correlated with lower DSS on univariate and multivariate analyses. In addition, treatment with concurrent chemoradiation therapy was independently associated with a higher DSS rate on multivariate analysis.ConclusionsPatients with UC have a high rate of relapse in the regional nodes and distant sites. External beam radiation therapy improves locoregional control in all stages and may improve survival in stage III patients who are at the highest risk of pelvic relapse.

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A multi-institutional cohort study of adjuvant therapy in stage I–II uterine carcinosarcoma

Gynecologic Oncology ◽

10.1016/j.ygyno.2012.06.020 ◽

2012 ◽

Vol 127 (1) ◽

pp. 22-26 ◽

Cited By ~ 51

Author(s):

Leigh A. Cantrell ◽

Laura Havrilesky ◽

Dominic T. Moore ◽

David O'Malley ◽

Margaret Liotta ◽

...

Keyword(s):

Cohort Study ◽

Adjuvant Therapy ◽

Stage I ◽

Uterine Carcinosarcoma

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Effect of adjuvant therapy on the prognosis in stage I/II uterine carcinosarcoma: A meta‐analysis

Journal of Obstetrics and Gynaecology Research ◽

10.1111/jog.14800 ◽

2021 ◽

Author(s):

Fei Zhao ◽

Ping Tan ◽

Chang Wang ◽

Xuechao Ji ◽

Aiping Chen

Keyword(s):

Adjuvant Therapy ◽

Meta Analysis ◽

Stage I ◽

Uterine Carcinosarcoma

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Effect of Adjuvant Therapy on Oncologic Outcomes of Surgically Confirmed Stage I Uterine Carcinosarcoma: a Turkish Gynecologic Oncology Study

Balkan Medical Journal ◽

10.4274/balkanmedj.galenos.2019.2018.12.75 ◽

2019 ◽

Vol 36 (4) ◽

pp. 229-234

Author(s):

Günsu Kimyon Cömert ◽

Osman Türkmen ◽

Gökhan Boyraz ◽

İbrahim Yalçın ◽

Duygu Altın ◽

...

Keyword(s):

Adjuvant Therapy ◽

Gynecologic Oncology ◽

Stage I ◽

Oncologic Outcomes ◽

Uterine Carcinosarcoma

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Omission of adjuvant therapy in stage I clear cell ovarian cancer: Review of the British Columbia (BC) cancer experience.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.5536 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. 5536-5536

Author(s):

Shiru Lucy Liu ◽

Anna Tinker

Keyword(s):

Ovarian Cancer ◽

Overall Survival ◽

Adjuvant Therapy ◽

Clinical Outcomes ◽

Group Performance ◽

Clear Cell ◽

Eastern Cooperative Oncology Group ◽

Stage I ◽

Stage Ia ◽

Sharp Dissection

5536 Background: Standard guidelines recommend adjuvant chemotherapy for stage I clear cell ovarian cancer (CCOC), despite data demonstrating excellent outcomes. Since 2012, the BC Cancer provincial treatment guidelines for surgically staged stage IA/B and IC1 (defined by intraoperative rupture only) CCOC has been to offer observation only. We reviewed the clinical outcomes of stage I CCOC patients since policy implementation. Methods: A retrospective, population-based cohort study of all stage I CCOC patients operated on between April 2012 and December 2017 was conducted. Patient, tumor, surgical and clinical outcome data were collected. Survival analysis was conducted using Kaplan-Meier methods. Results: 78 patients with stage I disease were identified (see Table). Among stage IC1 patients, 9 received adjuvant therapy despite provincial policy, 6 of which were due to sharp dissection. 40 patients with stages IA/B and IC1, who underwent post-operative observation, were included in the analysis. Median duration of follow-up was 36 months. Median age at diagnosis was 55 years and >50% patients had a Charlson Comorbidity Index of 0 (N= 26) and an Eastern Cooperative Oncology Group performance status of 0 (N=28) prior to diagnosis. Lymph node dissection was not performed in 20 patients. All 16 cases tested immunohistochemically for mismatch repair were intact, and 2 of 6 cases with tumour genomic sequencing had an AURKA aberration. There were 4 recurrences (10%), 3 of which were metastatic. 5-year disease-free survival is 90%, and 5-year overall survival is 95% for stage IA/B and 90% for stage IC1 (p=0.645). In comparison, 5-year overall survival for stage IC2 (surface involvement) and IC1 with sharp dissection (all received chemotherapy) is 82% and for stage IC3 (positive washings) is 23% (p<0.001). Conclusions: Outcomes of patients with stage I A/B and C1 CCOC remain excellent. Adjuvant therapy can be safely omitted, with low recurrence rates and survival over 90% at 5 years. Consideration of disease substage is valuable in predicting the clinical outcomes of stage I CCOC. [Table: see text]

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Multimodality adjuvant therapy and survival outcomes in stage I–IV uterine carcinosarcoma

International Journal of Gynecological Cancer ◽

10.1136/ijgc-2020-001315 ◽

2020 ◽

Vol 30 (7) ◽

pp. 1012-1017

Author(s):

Jennifer McEachron ◽

Taryn Heyman ◽

Lisa Shanahan ◽

Van Tran ◽

Monica Friedman ◽

...

Keyword(s):

Overall Survival ◽

Uterine Cancer ◽

Survival Rates ◽

Stage Iv ◽

Progression Free Survival ◽

Stage I ◽

High Recurrence Rate ◽

Uterine Carcinosarcoma ◽

Treatment Delays ◽

Free Survival

ObjectivesUterine carcinosarcoma is a rare, aggressive form of uterine cancer with a high recurrence rate and poor survival at all stages. We sought to evaluate the outcomes of patients treated with chemotherapy versus a combination of chemotherapy and radiation (chemoradiation) to determine survival.MethodsA multicenter retrospective analysis of patients with stage I–IV carcinosarcoma was conducted from January 2000 to December 2017. Inclusion criteria were primary surgical management, defined as hysterectomy ± salpingo-oophorectomy, comprehensive surgical staging and/or tumor debulking, followed by adjuvant chemotherapy or chemoradiation. Differences in the frequencies of stage, cytoreduction status, treatment delays and sites of disease recurrence were identified using Pearson’s χ2 test. Progression-free and overall survival rates were calculated using Kaplan-Meier estimates.ResultsFinal analysis included 148 patients; 40.5% (n=60) chemotherapy and 59.5% (n=88) chemoradiation. The mean age was 67 years (range 39–89). Stage distribution included 24.3% stage I, 12.2% stage II, 37.2% stage III, and 26.3% stage IV. There was no difference in the frequency of stage (p=0.81), cytoreduction status (p=0.61), treatment delays (p=0.57), or location of recurrence (p=0.97) between cohorts. The most frequent location of recurrence was the abdomen (50.0%). The median progression-free survival favored chemoradiation over chemotherapy (15 vs 11 months, respectively), as did the median overall survival (26 vs 20 months, respectively). Chemoradiation was associated with a statistically significant improvement in 2 year progression-free survival (22.5% vs 13.6%; p=0.006) and 2 year overall survival (50.0% vs 35.6%; p=0.018) compared with chemotherapy alone. On subanalysis of patients receiving chemoradiation, ‘sandwich sequencing’ (chemotherapy–radiation–chemotherapy) was associated with superior overall survival compared with alternate therapy sequences (chemotherapy–radiation and radiation–chemotherapy) (34 months vs 14 months and 14 months, respectively) (p=0.038).ConclusionsChemoradiation was associated with improvement in both progression-free and overall survival for all stages of carcinosarcoma compared with chemotherapy alone.

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