THE EFFECT OF CHEMOTHERAPY ON THE DIFFERENT COMPONENTS OF ADVANCED CARCINOSARCOMAS (MALIGNANT MIXED MESODERMAL TUMORS) OF THE FEMALE GENITAL-TRACT

The effect of chemotherapy on the different components of uterine and ovarian carcinosarcoma is largely unknown. This report describes six p atients with advanced carcinosarcoma, five of whom received 4 cycles o f doxorubicin and ifosfamide (AI) directed at the sarcomatous componen t of the tumor. Responses in these five patients at second-look laparo tomy were: one complete response, two partial responses (persistence o f only the carcinomatous component), one stable disease, and one progr essive disease (both components still present in both cases). Thereaft er 4 cycles of a cisplatin-based regimen were scheduled. Response to t he cisplatin-containing regimen was only evaluated clinically. The six th patient (with no macroscopic disease left after initial surgery) re ceived 6 cycles of a cisplatin-based chemotherapy from the onset and w as found to be in complete response at relaparotomy. Median progressio n-free survival for all patients was 15 months and median survival 21 months. A literature survey showed that carcinosarcoma differs from ad ult soft tissue sarcomas with respect to responsiveness to chemotherap y. Cisplatin and ifosfamide are active as single agents, whereas the r esponse to single-agent doxorubicin seems to be lower. The data sugges t, however, that superior response rates and increased survival times are achieved with cisplatin/doxorubicin-based chemotherapy. The sensit ivity of carcinosarcoma to cisplatin supports the recent view that car cinosarcoma of the female genital tract is possibly a high grade carci noma with metaplastic sarcomatous elements.