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Objective: Carcinosarcomas (CSs) and leiomyosarcomas (LMSs) are rare uterine cancers with high mortality. This study presents a dual institutional experience from two different university teaching hospitals (Mansoura and Zagazig Universities situated in the Delta of the Nile River in Egypt) with regard to the treatment modalities of those two types of uterine cancers aimed at establishing demographics and treatment outcomes.
Patients & Methods: The data from 12 uterine CS and 17 LMS patients treated at the Clinical Oncology Departments of Mansoura and Zagazig Universities from January 2012 to June 2018 were reviewed to evaluate demographics and treatment outcomes.
Results: The mean age of the patients was greater than 50 years. Abnormal uterine bleeding (AUB) was the most common presenting symptom.
Six CS (50%) patients underwent comprehensive surgical staging, while 4 patients underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH&BSO). Conversely, TAH&BSO was performed in 15 patients with LMS (88%).
Adjuvant radiotherapy was given to 6 CS (50%) and 4 LMS (24%) patients. Meanwhile, adjuvant chemotherapy was received by 5 CS (42%) and 8 LMS (47%) patients. Pelvic failure occurred in only the LMS group. Visceral metastasis occurred in both groups, while bone metastasis was encountered in only the CS group. The overall survival at 5 years was 53% and 32% in patients with CS and LMS, respectively.
Conclusion: AUB should be seriously investigated. Both diseases are aggressive despite early presentation and radical multimodality treatment. Local recurrence was reported in only the LMS group. Visceral metastasis occurred in both groups, unlike bone metastasis. New targeted therapies are urgently needed.
Roett MA. Genital cancers in women: uterine cancer. FP Essent. 2015;438:11-17.
Kurnit KC, Previs RA, Soliman PT, Westin SN, Klopp AH, Fellman BM, et al. Prognostic factors impacting survival in early stage uterine carcinosarcoma. Gynecol Oncol. 2018;3(18):1317-1319.
Denschlag D, Ulrich UA. Uterine carcinosarcomas diagnosis and management. Oncol Res Treat. 2018;41: 675-679.
O'Cearbhaill R, Hensley ML. Optimal management of uterine leiomyosarcoma. Expert Rev Anticancer Ther. 2010;10:153-169.
Ebner F, Wiedenmann S, Bekes I, Wolfgang J, de Gregorio N, de Gregorio A. Results of an internal audit on the survival of patients with uterine sarcoma. J Turk Ger Gynecol Assoc; 2018.
[Epub ahead of print]
Potikul C, Tangjitgamol S, Khunnarong J, Srijaipracharoen S, Thavaramara T, Pataradool K. Uterine Sarcoma: Clinical presentation, treatment and survival outcomes in Thailand. Asian Pac J. Cancer Prev. 2016;17:1759-1767.
Lakhman Y, Veeraraghavan H, Chaim J, Feier D, Goldman DA, Moskowitz CS, et al. Differentiation of uterine leiomyosarcoma from atypical leiomyoma: Diagnostic accuracy of qualitative MR imaging features and feasibility of texture analysis. Eur. Radiol. 2017;27: 2903-2915.
Pellanda AF, De Bari B, Deniaud-Alexandre E, Krengli M, Van Houtte P, Richetti A. Outcome and prognostic factors in 110 consecutive patients with primary uterine leiomyosarcoma: A rare cancer network study Chin. J. Cancer Res. 2017;29:521-532.
Venigalla S, Chowdhry AK, Shalowitz DI. Survival implications of staging lymphadenectomy for non-endometrioid endometrial cancers. Gynecol Oncol. 2018;149:531-538.
Manzerova J, Sison CP, Gupta D, Holcomb K, Caputo TA, Parashar B, et al. Adjuvant radiation therapy in uterine carcinosarcoma: A population-based analysis of patient demographic and clinical characteristics, patterns of care and outcomes. Gynecol Oncol. 2016;141:225-230.
Versluis MAC, Pielsticker C, van der Aa MA, de Bruyn M, Hollema H, Nijman HW. Lymphadenectomy and adjuvant therapy improve survival with uterine carcinosarcoma: A large retrospective cohort study Oncology. 2018;95: 100-108.
Wong AT1, Lee YC, Schwartz D, Lee A, Shao M, Han P, et al. Use of adjuvant chemotherapy, radiation therapy, or combined modality therapy and the impact on survival for uterine carcinosarcomal limited to the pelvis. Int J. Gynecol Cancer. 2017;27:1171-1177.
Dandamudi RK, Aslam S, Walji N, El-Modir A, Fernando I. Chemotherapy for uterine carcinosarcoma with carboplatin, ifosfamide and mesna. Anticancer Res 2015;35:4841-4847.
Guttmann DM, Li H, Sevak P, Grover S, Jacobson G, Feldman A, et al. The impact of adjuvant therapy on survival and recurrence patterns in women with early-stage uterine carcinosarcoma: A multi-institutional study. Int J Gynecol Cancer. 2016;26:141-148.
Menczer J. Review of recommended treatment of uterine carcinosarcoma. Curr Treat. Options Oncol. 2015;16:53-62.
Günthert AR1, Ackermann S, Beckmann MW, Camara O, Kiesel L, Rensing K, Schröder W, Steiner E, Emons G. Arbeitsgemeinschaft Gynaekologische Onkologie Phase II study of weekly docetaxel in patients with recurrent or metastatic endometrial cancer: AGO Uterus-4. Gynecol Oncol. 2007;104:86-90.
Roberts ME, Aynardi JT, Chu CS. Uterine leiomyosarcoma: A review of the literature and update on management options. Gynecol Oncol. 2018;151:562-572.
Raspagliesi F, Maltese G, Bogani G, Fucà G, Lepori S, De Iaco P,et al. Morcellation worsens survival outcomes in patients with undiagnosed uterine leiomyosarcomas: A retrospective MITO group study. Gynecol Oncol. 2017;144:90-95.
Reed NS1, Mangioni C, Malmström H, Scarfone G, Poveda A, Pecorelli S, et al. European organisation for research and treatment of cancer gynaecological cancer group phase III randomised study to evaluate the role of adjuvant pelvic radiotherapy in the treatment of uterine sarcomas stages I and II: An European Organisation for Research and Treatment of Cancer. Gynaecological cancer group study (protocol 55874). Eur J Cancer. 2008;44:808-818.
Sorbe B, Johansson B. Prophylactic pelvic irradiation as part of primary therapy in uterine sarcomas. Int J. Oncol. 2008;32:1111-1117.
Friedman CF, Hensley ML. Options for adjuvant therapy for uterine leiomyosarcoma. Curr Treat Options Oncol. 2018;8:19:7-10.
Ducie JA, Leitao MM Jr. The role of adjuvant therapy in uterine leiomyosarcoma. Expert Rev Anticancer Ther. 2016;16:45-55.
Kim MK, Lee TS, Kim JW, Lee JM, Kim BJ, Seong SJ. Management of leimyosarcoma: A survey among members of the Korean Gynecologic Oncology Group. Int J. Gynecol Cancer. 2017;27: 1912-1918.
Sorbe B, Paulsson G, Andersson S, Steineck G. A population-based series of uterine carcinosarcomas with long- term follow-up. Acta Oncol. 2013;52:759-766.
Tirumani SH, Deaver P, Shinagare AB, Tirumani H, Hornick JL, George S, et al. Metastatic pattern of uterine leiomyosarcoma: retrospective analysis of the predictors and outcome in 113 patients. J. Gynecol Oncol. 2014;25:306-312.
Clairwood M, Yasuda M, Belazarian L, Deng. A. Unusual cutaneous metastasis of uterine carcinosarcoma: A case report and review of the literature. Am J Dermatopathol. 2016;38:366-369.
Rice BM1, Todd NW, Jensen R, Rush SM, Rogers W. Metastatic calcaneal lesion associated with uterine carcinosarcoma. J Foot Ankle Surg. 2014; 53:364-368.
Bartosch C, Afonso M, Pires-Luís AS, Galaghar A, Guimarães M, Antunes L, et al. Distant metastases in uterine leiomyosarcomas: The wide variety of body sites and time intervals to metastatic relapse. Int J Gynecol Pathol. 2017;36:31-41.