THE IMPACT OF ADJUVANT RADIOTHERAPY ON CARCINOSARCOMA OF THE UTERUS

Background. The role of adjuvant radiotherapy in the setting of uterin e carcinosarcoma has not been clearly established. Methods. A retrospe ctive review of 60 patients receiving definitive therapy for carcinosa rcoma of the uterus was undertaken al a single institution, Twenty-nin e of 60 patients were treated with adjuvant radiotherapy. Results. The addition of radiotherapy significantly reduced the local recurrence r ate from 55% (17 patients) to 3% (1 patient). Adjuvant radiotherapy re duced the risk of distant failure and death in patients with disease c onfined to the uterus but did not impact distant recurrence or surviva l in stage III patients. Increasing stage and depth of myometrial tumo r invasion were negatively associated viith overall survival and disea se-free survival but had no impact on local recurrence rates. The nucl ear grade of the epithelial component was predictive of local recurren ce (P = 0.0592), but epithelial architectural grade, grade of stromal component, and stromal versus epithelial predominance did not provide prognostic information. The relative risk of local recurrence of unirr adiated patients versus irradiated patients was 17.54 (P = 0.0055) aft er adjusting for nuclear grade of the epithelial component. Conclusion s. Local failure represents a significant site of failure in the absen ce of adjuvant radiotherapy, The improvement in local failure rates wi th the addition of radiotherapy translates into an improvement in dist ant failure rates and survival only for patients with stage I/II disea se, Epithelial nuclear grade, in addition to depth of myometrial invas ion and stage, provides important prognostic information. Epithelial a rchitectural grade, stromal grade, type of stromal component (homologo us versus heterologous), and predominance of either stromal or epithel ial component were not found to be significant prognostic factors. (C) 1998 Academic Press.