The Role of Postoperative Radiotherapy for Carcinosarcoma of the Uterus
Abstract
:Simple Summary
Abstract
1. Introduction
2. Results
2.1. Prospective Trials
2.2. Meta-Analyses
2.3. Cancer Registry Data
3. Discussion
4. Materials and Methods
5. Conclusions
Author Contributions
Funding
Conflicts of Interest
References
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Authors | Data Source (Time Period) | Inclusion Criteria | n | Main Result | Comment |
---|---|---|---|---|---|
Nama et al., 2020 [14] | SEER (1973–2010) | stages I–IV | 3706 | RT independently associated with survival (OR 0.1, CI = 0.02–0.06, p < 0.005) | no specific data by stage or by type of RT (EBRT, VBT) |
Li et al., 2019 [15] | SEER (2004–2013) | stages I–III | 1069 | multivariate Cox analysis: overall survival benefit for EBRT HR 0.72 (0.53–0.99; p = 0.042), VBT HR 0.55 (0.37–0.80; p = 0.002), combination HR 0.47 (0.29–0.77; p = 0.003) propensity-score matched: overall survival benefit EBRT HR 0.65 (0.45–0.93; p = 0.02), VBT 0.62 (0.40–0.95; p = 0.029), combination HR 0.47 (0.26–0.85; p = 0.013) | |
Manzerova et al., 2016 [16] | SEER (1999–2010) | stages I–IV | 2342 | EBRT effect in most recent time period 2005–2010: crude 5-year OS with EBRT 50.9%, without 33% (p < 0.0001); median OS stage I with RT 71 mo vs. without EBRT 43 mo; stage II 52 vs. 18 mo.; stage III 39 vs. 29 mo (all p ≤ 0.007), stage IV 14 vs. 9 mo (p < 0.10) | VBT not studied: OS effects of EBRT remain after correction for prognostic factors |
Patel et al., 2015 [17] | SEER (1998–2010) | stages I–II | 1581 | multivariate Cox model: OS improved by VBT vs. no RT HR 0.67 (CI 0.47–0.95; p = 0.024), EBRT vs. no RT HR 0.90 (0.76–1.06; p = 0.22) | authors conclude EBRT not better than VBT |
Odei et al., 2018 [18] | SEER (2004–2012) | stages I–IV receiving chemotherapy (±RT) | 3538 | multivariate analysis: OS benefit from addition of RT to chemotherapy, HR 0.67 (0.55–0.81); no significant difference OS between EBRT and VBT; propensity-score matched: OS improvement by addition of RT, HR 0.68 (0.61–0.77; p < 0.01) | RT was either EBRT + VBT or VBT alone, OS benefit from RT in most subgroups (propensity-score matched), including FIGO stages I–III and with/without lymph node surgery |
Authors | Data Source (Time Period) | Inclusion Criteria | n | Main Result | Comment |
---|---|---|---|---|---|
Stokes et al., 2018 [19] | NCDB (2004–2012) | stages I–III | 2303 | multivariate analysis: overall survival improved by combination EBRT + VBT, HR 0.72 [0.58–0.89; p < 0.01), not by EBRT alone, HR 0.93 (0.79–1.10; p = 0.41) or VBT alone, HR 0.84 (0.68–1.02; p = 0.09); propensity-score-matched analysis: overall survival improved by combination EBRT + VBT, HR 0.74 (0.58–0.96; p = 0.02), not by EBRT alone, HR 0.89 (0.73–1.07; p = 0.34) or by VBT alone, HR 0.80 (0.63–1.03; p = 0.09) | data for individual FIGO stages only in unmatched groups: OS advantage of VBT in stage II |
Shinde et al., 2018 [20] | NCDB (2004–2015) | stage IA | 2701 | multivariate analysis: OS benefit from VBT, HR 0.80, p = 0.047; not from EBRT, HR 0.89, p = 0.28 | |
Seagle et al., 2017 [21] | NCDB (1998–2013) | stage I | 5614 | multivariate analysis: improvement of OS by EBRT, HR 0.91 (0.82–1.01; p = 0.08), by VBT, HR 0.81 (0.70–0.95; p = 0.07), by EBRT + VBT, HR 0.88 (0.73–1.06; p = 0.16); propensity-score-matched analysis: VBT associated with improved OS, HR 0.83 (0.70–0.97; p = 0.02); in subgroup with pathologically negative lymph nodes HR 0.80 (0.67–0.96; p = 0.01) | |
Wong et al. [22] | NCDB (2004–2011) | stages I–IIIC1 | 4906 | node-negative patients: 5-year OS with chemo + EBRT 65.2% vs. chemo + VBT 70.4% (p = 0.07); node-positive with chemo + EBRT 50.5% vs. chemo + VBT 31.7% (p = 0.07); multivariate analysis: OS benefit with chemo + RT any modality, HR 0.50 (0.44–0.57; p < 0.001), not from RT alone | in some analyses RT modality (EBRT vs. VBT) not differentiated, both considered as RT |
Authors | Data Source (Time Period) | Inclusion Criteria | n | Main Result | Comment |
---|---|---|---|---|---|
van Welden et al., 2020 [23] | Netherlands Cancer Registry (2005–2016) | stage III | 132 | combination of chemotherapy and EBRT associated with improved OS compared to chemotherapy alone, HR 2.49 (1.24–4.99; p = 0.01), to EBRT alone, HR 2.53 (1.29 –4.97; p = 0.007) | |
Versluis et al., 2018 [24] | Netherlands Cancer Registry (1993–2012) | stages I–IV | 1140 | multivariate analysis: RT improves OS, HR 0.65 (0.55–0.77; p < 0.001), strongest effect from chemotherapy + RT, HR 0.25 (0.14–0.47; p < 0.001); in subgroup lymphadenectomy node-negative: nonsignificant OS effect of RT, HR 0.65 (0.39–1.09, p = 0.1) and of chemotherapy + RT, HR 0.68 (0.20–3.24; p = 0.45; in subgroup lymphadenectomy node-positive significant OS effect of RT, HR 0.17 (0.07–0.39; p < 0.001) and of chemotherapy + RT, HR 0.04 (0.03–0.18; p < 0.001) | modality of RT (EBRT vs. VBT) not specified |
Sorbe et al., 2013 [25] | Sweden, regional registry (1973–2007) | stages I–IV | 322 | stages I–II crude locoregional recurrence 8% with EBRT (±VBT) vs. 19% without (p = 0.0103); stages III–IV multivariate analysis: improvement of relapse-free survival by addition of EBRT (±VBT) to chemotherapy, HR 0.62 (0.46–0.85) |
Stage | EBRT Alone | VBT Alone | EBRT + VBT | Comment |
---|---|---|---|---|
IA | (+) | + | (+) | best OS data for VBT alone |
IB | + | + | + | no clear advantage for any modality or combination |
II | (+) | (+) | + | best OS data for combination |
III | (+) | (+) | + | best OS data for combination |
IV | (+) | − | 0 | limited data for EBRT in stage IV |
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Vordermark, D.; Medenwald, D.; Izaguirre, V.; Sieker, F.; Marnitz, S. The Role of Postoperative Radiotherapy for Carcinosarcoma of the Uterus. Cancers 2020, 12, 3573. https://doi.org/10.3390/cancers12123573
Vordermark D, Medenwald D, Izaguirre V, Sieker F, Marnitz S. The Role of Postoperative Radiotherapy for Carcinosarcoma of the Uterus. Cancers. 2020; 12(12):3573. https://doi.org/10.3390/cancers12123573
Chicago/Turabian StyleVordermark, Dirk, Daniel Medenwald, Victor Izaguirre, Frank Sieker, and Simone Marnitz. 2020. "The Role of Postoperative Radiotherapy for Carcinosarcoma of the Uterus" Cancers 12, no. 12: 3573. https://doi.org/10.3390/cancers12123573