Radiation Oncology/Uterine Sarcoma/Overview

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Uterine Sarcoma Overview

  • Comprise <1% of GYN malignancies and 2-5% of uterine malignancies
  • Three distinct tissues of origin:
    • Carcinosarcoma (mixed mullerian tumor): endometrium, accounts for 40-50%. High frequency of TP53 mutations.
      • Subtypes:
        • Heterologous type:
          • Sarcomatous components derived from skeletal muscle, cartilage, or bone; frequently rhabdomyosarcomas or chondrosarcomas
          • More aggressive, poorer prognosis, higher risk of recurrence
        • Homologous type: Sarcomatous component derived from endometrium, usually resemble high-grade undifferentiated sarcoma or fibrosarcoma
      • GOG 150: Whole Abdominal Irradiation (WAI) vs Cisplatin-Ifosfamide and Mesna (CIM) as post-surgical therapy
      • 206 patients with uterine carcinosarcoma
        • Stages I-IV eligible as long as no demonstrable parenchymal hepatic involvement or extra-abdominal distant disease
        • All patients underwent TAH, BSO, and maximal resection of all gross intra-abdominal/pelvic disease, including macroscopically involved pelvic and para-aortic nodes, leaving no residual disease any larger than 1 cm
        • WAI: 1 cm margins on the diaphragm superiorly, the inguinal ligament inferiorly, and the lateral aspect of the peritoneal margin laterally; AP/PA; total dose 30 Gy. 20 Gy 4-field boost to true pelvis.
        • CIM: cisplatin (20 mg/m2/day IV × 4 days) that was to be followed by a one hour IV administration of Ifosfamide (1.5 g/m2/day IV × 4 days) with mesna (120 mg/m2 IV bolus over 15 minutes on day one, followed by 1.5 g/m2/day IV continuous infusion × 4 days beginning with day one) every three weeks for three cycles.
        • Primary endpoints: Death and recurrence rates
          • No statistically significant difference in time to recurrence (at 5 years, 58% WAI vs 52% CIM)
          • No statistically significant difference in survival time (at 5 years, 35% WAI vs 45% CIM)
          • Slightly more vaginal recurrences in CIM group and more abdominal recurrences in WAI group, but not statistically significant
        • AEs: Higher grade 3 or 4 acute anemia and neuropathy in CIM group, higher grade 2-4 gastrointestinal events in WAI group. Two WAI patients died of radiation hepatitis. One CIM patient died of acute port infection complicated by neutropenia.