Vaginal brachytherapy for early-stage carcinosarcoma of the uterus

Lindsay C. Brown, Ivy A. Petersen, Michael G. Haddock, Jamie N. Bakkum-Gamez, Larissa J. Lee, Nicole C. Cimbak, Ross S. Berkowitz, Akila Viswanathan

Research output: Contribution to journalArticle

Abstract

Objective: Uterine carcinosarcoma (CS) is an aggressive malignancy and the optimal adjuvant treatment is not well-established. We report outcomes with vaginal brachytherapy (VB) for women with early-stage CS. Methods and Materials: A multi-institutional retrospective study of Stage I-II CS treated with hysterectomy, surgical staging, and adjuvant high-dose-rate VB without external-beam pelvic radiotherapy was performed. Rates of vaginal control, pelvic control, locoregional control, disease-free survival, and overall survival were determined using the Kaplan-Meier method. Results: 33 patients were identified. Prescribed VB dose was 21Gy in three fractions (n= 15 [45%]) or 24Gy in six fractions (n= 18 [55%]). Eighteen patients (55%) received chemotherapy. Median followup was 2.0years. Twenty-seven patients (82%) underwent pelvic lymphadenectomy, 5 (15%) had nodal sampling, and 1 (3%) had no lymph node assessment. Relapse occurred in 11 patients (33%), all of whom had lymph node evaluation. Locoregional relapse was a component of failure in 6 patients (18%), of whom 3 (9%) failed in the pelvis alone. Three patients (9%) had simultaneous distant and locoregional relapse (two vaginal, one pelvic). Five additional patients (15%) had distant relapse. Six of the 11 patients (55%) with disease recurrence received chemotherapy. Two-year vaginal control and pelvic control were 94% and 87%. Two-year locoregional control, disease-free survival, and overall survival were 81%, 66%, and 79%. Conclusions: Despite having early-stage disease and treatment with VB, patients in this series had relatively high rates of local and distant relapse. Patients who undergo lymphadenectomy and VB remain at risk for relapse. Novel treatment strategies are needed.

Original languageEnglish (US)
Pages (from-to)433-439
Number of pages7
JournalBrachytherapy
Volume14
Issue number4
DOIs
StatePublished - Jul 1 2015
Externally publishedYes

Fingerprint

Carcinosarcoma
Brachytherapy
Uterus
Recurrence
Lymph Node Excision
Disease-Free Survival
Lymph Nodes
Drug Therapy
Survival
Hysterectomy
Pelvis
Radiotherapy
Therapeutics
Retrospective Studies

Keywords

  • Carcinosarcoma
  • Radiation therapy
  • Uterine cancer

ASJC Scopus subject areas

  • Medicine(all)
  • Oncology
  • Radiology Nuclear Medicine and imaging

Cite this

Brown, L. C., Petersen, I. A., Haddock, M. G., Bakkum-Gamez, J. N., Lee, L. J., Cimbak, N. C., ... Viswanathan, A. (2015). Vaginal brachytherapy for early-stage carcinosarcoma of the uterus. Brachytherapy, 14(4), 433-439. https://doi.org/10.1016/j.brachy.2015.02.194

Vaginal brachytherapy for early-stage carcinosarcoma of the uterus. / Brown, Lindsay C.; Petersen, Ivy A.; Haddock, Michael G.; Bakkum-Gamez, Jamie N.; Lee, Larissa J.; Cimbak, Nicole C.; Berkowitz, Ross S.; Viswanathan, Akila.

In: Brachytherapy, Vol. 14, No. 4, 01.07.2015, p. 433-439.

Research output: Contribution to journalArticle

Brown, LC, Petersen, IA, Haddock, MG, Bakkum-Gamez, JN, Lee, LJ, Cimbak, NC, Berkowitz, RS & Viswanathan, A 2015, 'Vaginal brachytherapy for early-stage carcinosarcoma of the uterus', Brachytherapy, vol. 14, no. 4, pp. 433-439. https://doi.org/10.1016/j.brachy.2015.02.194
Brown LC, Petersen IA, Haddock MG, Bakkum-Gamez JN, Lee LJ, Cimbak NC et al. Vaginal brachytherapy for early-stage carcinosarcoma of the uterus. Brachytherapy. 2015 Jul 1;14(4):433-439. https://doi.org/10.1016/j.brachy.2015.02.194
Brown, Lindsay C. ; Petersen, Ivy A. ; Haddock, Michael G. ; Bakkum-Gamez, Jamie N. ; Lee, Larissa J. ; Cimbak, Nicole C. ; Berkowitz, Ross S. ; Viswanathan, Akila. / Vaginal brachytherapy for early-stage carcinosarcoma of the uterus. In: Brachytherapy. 2015 ; Vol. 14, No. 4. pp. 433-439.
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abstract = "Objective: Uterine carcinosarcoma (CS) is an aggressive malignancy and the optimal adjuvant treatment is not well-established. We report outcomes with vaginal brachytherapy (VB) for women with early-stage CS. Methods and Materials: A multi-institutional retrospective study of Stage I-II CS treated with hysterectomy, surgical staging, and adjuvant high-dose-rate VB without external-beam pelvic radiotherapy was performed. Rates of vaginal control, pelvic control, locoregional control, disease-free survival, and overall survival were determined using the Kaplan-Meier method. Results: 33 patients were identified. Prescribed VB dose was 21Gy in three fractions (n= 15 [45{\%}]) or 24Gy in six fractions (n= 18 [55{\%}]). Eighteen patients (55{\%}) received chemotherapy. Median followup was 2.0years. Twenty-seven patients (82{\%}) underwent pelvic lymphadenectomy, 5 (15{\%}) had nodal sampling, and 1 (3{\%}) had no lymph node assessment. Relapse occurred in 11 patients (33{\%}), all of whom had lymph node evaluation. Locoregional relapse was a component of failure in 6 patients (18{\%}), of whom 3 (9{\%}) failed in the pelvis alone. Three patients (9{\%}) had simultaneous distant and locoregional relapse (two vaginal, one pelvic). Five additional patients (15{\%}) had distant relapse. Six of the 11 patients (55{\%}) with disease recurrence received chemotherapy. Two-year vaginal control and pelvic control were 94{\%} and 87{\%}. Two-year locoregional control, disease-free survival, and overall survival were 81{\%}, 66{\%}, and 79{\%}. Conclusions: Despite having early-stage disease and treatment with VB, patients in this series had relatively high rates of local and distant relapse. Patients who undergo lymphadenectomy and VB remain at risk for relapse. Novel treatment strategies are needed.",
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AU - Petersen, Ivy A.

AU - Haddock, Michael G.

AU - Bakkum-Gamez, Jamie N.

AU - Lee, Larissa J.

AU - Cimbak, Nicole C.

AU - Berkowitz, Ross S.

AU - Viswanathan, Akila

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AB - Objective: Uterine carcinosarcoma (CS) is an aggressive malignancy and the optimal adjuvant treatment is not well-established. We report outcomes with vaginal brachytherapy (VB) for women with early-stage CS. Methods and Materials: A multi-institutional retrospective study of Stage I-II CS treated with hysterectomy, surgical staging, and adjuvant high-dose-rate VB without external-beam pelvic radiotherapy was performed. Rates of vaginal control, pelvic control, locoregional control, disease-free survival, and overall survival were determined using the Kaplan-Meier method. Results: 33 patients were identified. Prescribed VB dose was 21Gy in three fractions (n= 15 [45%]) or 24Gy in six fractions (n= 18 [55%]). Eighteen patients (55%) received chemotherapy. Median followup was 2.0years. Twenty-seven patients (82%) underwent pelvic lymphadenectomy, 5 (15%) had nodal sampling, and 1 (3%) had no lymph node assessment. Relapse occurred in 11 patients (33%), all of whom had lymph node evaluation. Locoregional relapse was a component of failure in 6 patients (18%), of whom 3 (9%) failed in the pelvis alone. Three patients (9%) had simultaneous distant and locoregional relapse (two vaginal, one pelvic). Five additional patients (15%) had distant relapse. Six of the 11 patients (55%) with disease recurrence received chemotherapy. Two-year vaginal control and pelvic control were 94% and 87%. Two-year locoregional control, disease-free survival, and overall survival were 81%, 66%, and 79%. Conclusions: Despite having early-stage disease and treatment with VB, patients in this series had relatively high rates of local and distant relapse. Patients who undergo lymphadenectomy and VB remain at risk for relapse. Novel treatment strategies are needed.

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KW - Radiation therapy

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