Purpose: In the postoperative management of uterine carcinosarcoma (UCS), the roles of individual radiotherapy (RT) modalities, chiefly external-beam radiotherapy (EBRT) and brachytherapy (BT), remain undefined. We analyzed the survival impact of EBRT and BT using the National Cancer Database.
Methods and materials: We abstracted women diagnosed with UCS from 2004 to 2012 who received hysterectomy and had complete RT information. Cox multivariate analysis and propensity-score matched analyses were used to compare survival among radiotherapeutic approaches.
Results: We identified 1229 women receiving no radiotherapy, 472 receiving EBRT alone, 331 receiving BT alone, and 271 receiving EBRT+BT. On multivariate analysis of the entire analytic cohort, survival was significantly improved among patients receiving EBRT+BT combination (hazard ratio [HR] 0.72, 95% confidence interval [CI] = 0.58-0.89, p < 0.01), but not among those receiving EBRT alone (HR 0.93, 95% CI = 0.79-1.10, p = 0.41) or BT alone (HR 0.84, 95% CI = 0.68-1.03, p = 0.09). These results were confirmed on propensity-score matches for EBRT vs. no RT (HR 0.89, 95% CI = 0.73-1.07, p = 0.34), BT vs. no RT (HR 0.80, 95% CI = 0.63-1.03, p = 0.09), and EBRT+BT vs. no RT (HR 0.74, 95% CI = 0.58-0.96, p = 0.02).
Conclusions: EBRT+BT combination is associated with an overall survival advantage in UCS and warrants consideration in the adjuvant management of this disease.
Keywords: Brachytherapy; Carcinosarcoma; External-beam radiotherapy; Radiation therapy; Uterine cancer.
Copyright © 2017 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.