To evaluate our experience with ovarian carcinosarcoma and identify prognostic factors.
Thirty-one cases of ovarian carcinosarcoma were identified over a 6-year time period through tumor registry and pathology records. Fisher exact test and log rank using Kaplan-Meier method (P < 0.05) were used to compare variables with outcome.
All 31 patients underwent initial surgical treatment with an appropriate staging procedure. Stage distribution: 1 stage I, 6 stage II, 23 stage III, and 1 stage IV. The median follow-up was 28 months. The median survival for the entire group was 21 months. Early vs. advanced stage significantly influenced progression-free interval, P = 0.05. Nineteen patients were found to have stage IIIC disease and required debulking procedures. In patients with stage IIIC disease, presence of residual disease was associated with decreased overall survival, P = 0.03. 29 patients received adjuvant chemotherapy with 11 patients receiving ifosfamide/cisplatin and 16 patients receiving carboplatin/taxol. Progression-free interval was improved with the use of ifosfamide/cisplatin vs. carboplatin/taxol. The median PFI was 12 months in the carbo/taxol group and has not been reached in the ifos/cisplatin group (P = 0.005). The overall survival was also significantly improved with the use of ifosfamide/cisplatin, P = 0.03. In advanced stage patients, overall survival was not significantly influenced by type of adjuvant chemotherapy administered, P = 0.13.
Ovarian carcinosarcoma has a poor overall prognosis with median survival rates reported in the literature ranging from 7-10 months. Our series, although limited by a small number of patients, exhibits a more encouraging median survival of 21 months for the overall group. Aggressive debulking to eliminate residual disease and the use of ifosfamide/cisplatin chemotherapy seem to be factors in this improved outcome.
"Ifosfamide, an analog of cyclophosphamide, is an active agent in gynecologic cancers, especially sarcomas (Dusenbery et al., 2005; Kanjeekal et al., 2005). Its activity in ovarian and uterine malignant mixed mesodermal tumors (MMMT) has been demonstrated in multiple studies (Homesley et al., 2007; Mano et al., 2007; Rutledge et al., 2006). Unfortunately, it is commonly associated with neurotoxicity in patients with protein malnutrition. "
[Show abstract][Hide abstract] ABSTRACT: Highlights
Aprepitant combined with ifosfamide may lead to encephalopathy.
Aprepitant–ifosfamide induced encephalopathy was of short duration in these cases.
"In ovarian and endometrial carcinosarcomas, ifosfamide  and platinum    have demonstrated efficacy. The carboplatin and paclitaxel combination has been reported with a response rate up to 72% in carcinosarcomas of the reproductive tract and seems to have a more favorable toxicity profile than ifosfamide or cisplatin   . Aggressive combinations of anthracylines, alkalating agents, and platinums are active but have significant toxicity, with some reports demonstrating almost two-thirds of the treatment group delaying or changing treatment  . "
[Show abstract][Hide abstract] ABSTRACT: Objective. To define survival patterns of women with ovarian carcinosarcoma based on patient, tumor, and treatment characteristics. Methods/Materials. A single-institution, retrospective analysis of women diagnosed with ovarian carcinosarcoma from February 1993 to May 2009 was performed. Survival was analyzed with Cox proportional hazards ratios and Kaplan Meier tests. Results. Forty-seven cases of primary ovarian carcinosarcoma were identified. Age conveyed an HR 3.28 (95% CI 1.51-7.11, P = 0.003) for death. Compared to Stages I-II, Stage III carried an HR for death of 4.75 (95% CI 1.16-19.4, P = 0.03) and Stage IV disease an HR of 9.13 (95% CI 1.76-47.45, P = 0.009). Compared to those with microscopic residual, women with >1 cm diameter of residual disease after primary cytoreductive surgery had an HR for death of 4.71 (95% CI 1.84-12.09, P = 0.001). At analysis, 59.1% of those who received platinum-based chemotherapy were alive, compared to 23.1% of those who received nonplatinum-based chemotherapy (P = 0.08). Conclusions. Age, stage, and cytoreduction to no gross residual disease are associated with improved survival in women with ovarian carcinosarcoma. Complete surgical cytoreduction should be the goal of surgical management when possible, but the ideal adjuvant treatment regimen remains unclear.
Obstetrics and Gynecology International 05/2013; 2013(8):490508. DOI:10.1155/2013/490508
"Although the overall survival was improved with the use of ifosfamide and cisplatin , there was no significant advantage for the advancedstage subgroup. However, taxan-based regimens were more tolerable than ifosfamide-based regimens . Our experience with patients who were treated with adjuvant platinum with taxan or ifosfamide combinations was consistent with the reported literature. "
[Show abstract][Hide abstract] ABSTRACT: To evaluate the clinicopathological prognostic factors and outcome of chemotherapy in ovarian carcinosarcomas.
We reviewed the records of 26 patients treated from 1990 to 2006 at the Oncology Institute of Istanbul University. Clinical data including demographics, stage, surgery, chemotherapy, and survival were collected from patients' charts.
All patients underwent initial debulking surgery. Optimal debulking was achieved in 21 (81%) patients. The most striking clinicopathological finding was the high incidence of hemorrhagic ascites (n: 6) which was observed in 60% of the patients with ascites (n: 10). The overall median survival of the patients was 26 months. Residual disease was associated with a decreased overall survival, P=0.04. Median survival (50 months vs 9.7 months, P=0.042) of the patients with early stage disease were longer than the patients with advanced stage. Twenty-two patients received platinum-based combination chemotherapy. There was a trend for increased median survival in the patients who were treated with carboplatin/paclitaxel combination (P=0.066). Although the numbers were insufficient for statistical evaluation, the patients treated with ifosfamide combinations had improved survival (36 months vs 26 months). However, when the patients treated with ifosfamide and carboplatin/paclitaxel combinations were combined, survival was statistically improved compared to the other regimens (36 months vs 9.7 months, P=0.04). Chemotherapy regimens containing doxorubicin or cyclophosphamide were not encouraging. Stage (P=0.02) and adjuvant platinum-based chemotherapy containing either paclitaxel or ifosfamide (P=0.024) remained predictive of outcome in the multivariate analysis.
Hemorrhagic ascites can be used in the initial differential diagnosis of ovarian carcinosarcomas. Stage, optimal debulking and type of adjuvant therapy were statistically significant prognostic predictors of ovarian carcinosarcomas. We advise that patients with ovarian carcinosarcomas should be treated by optimal cytoreduction followed by adjuvant platinum/taxan or platinum/ifosfamide combinations.
Rajitha Lokadasan, K Ratheesan, Renu Sukumaran, Sindhu P Nair
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