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Clinical significance of radiotherapy in patients with primary uterine carcinosarcoma: a multicenter retrospective study (KROG 13-08)

Authors
 Jihye Cha  ;  Young Seok Kim  ;  Won Park  ;  Hak Jae Kim  ;  Joo-Young Kim  ;  Jin Hee Kim  ;  Juree Kim  ;  Won Sup Yoon  ;  Jun Won Kim  ;  Yong Bae Kim 
Citation
 JOURNAL OF GYNECOLOGIC ONCOLOGY, Vol.27(6) : 58, 2016 
Journal Title
 JOURNAL OF GYNECOLOGIC ONCOLOGY 
ISSN
 2005-0380 
Issue Date
2016
MeSH
Adult ; Aged ; Aged, 80 and over ; Carcinosarcoma/mortality ; Carcinosarcoma/radiotherapy* ; Carcinosarcoma/surgery ; Chemotherapy, Adjuvant ; Female ; Humans ; Hysterectomy* ; Kaplan-Meier Estimate ; Lymph Node Excision ; Lymphatic Metastasis ; Middle Aged ; Neoplasm Recurrence, Local/prevention & control ; Proportional Hazards Models ; Radiotherapy, Adjuvant*/adverse effects ; Retrospective Studies ; Survival Rate ; Uterine Neoplasms/mortality ; Uterine Neoplasms/radiotherapy* ; Uterine Neoplasms/surgery
Keywords
Locoregional Control ; Radiotherapy, Adjuvant ; Uterine Carcinosarcoma
Abstract
OBJECTIVE: To investigate the role of radiotherapy (RT) in patients who underwent hysterectomy for uterine carcinosarcoma (UCS). METHODS: Patients with the International Federation of Gynecology and Obstetrics stage I-IVa UCS who were treated between 1990 and 2012 were identified retrospectively in a multi-institutional database. Of 235 identified patients, 97 (41.3%) received adjuvant RT. Twenty-two patients with a history of previous pelvic RT were analyzed separately. Survival outcomes were assessed using the Kaplan-Meier method and Cox proportional hazards model. RESULTS: Patients with a previous history of pelvic RT had poor survival outcomes, and 72.6% of these patients experienced locoregional recurrence; however, none received RT after a diagnosis of UCS. Univariate analyses revealed that pelvic lymphadenectomy (PLND) and para-aortic lymph node sampling were significant factors for locoregional recurrence-free survival (LRRFS) and disease-free survival (DFS). Among patients without previous pelvic RT, the percentage of locoregional failure was lower for those who received adjuvant RT than for those who did not (28.5% vs. 17.5%, p=0.107). Multivariate analysis revealed significant correlations between PLND and LRRFS, distant metastasis-free survival, and DFS. In subgroup analyses, RT significantly improved the 5-year LRRFS rate of patients who did not undergo PLND (52.7% vs. 18.7% for non-RT, p<0.001). CONCLUSION: Adjuvant RT decreased the risk of locoregional recurrence after hysterectomy for UCS, particularly in patients without surgical nodal staging. Given the poorer locoregional outcomes of patients previously subjected to pelvic RT, meticulous re-administration of RT might improve locoregional control while leading to less toxicity in these patients.
Files in This Item:
T201603655.pdf Download
DOI
10.3802/jgo.2016.27.e58
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
Yonsei Authors
Kim, Yong Bae(김용배) ORCID logo https://orcid.org/0000-0001-7573-6862
Kim, Jun Won(김준원) ORCID logo https://orcid.org/0000-0003-1358-364X
Cha, Ji Hye(차지혜)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/152110
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