A population-based series of uterine carcinosarcomas with long-term follow-up

Figures & data

Table I. Tumor characteristics of the complete series (n= 322).

	Number	Percent
Stage
I	158	49.1
II	39	12.1
III	67	20.8
IV	58	18.0
Histology
Carcinosarcomas	322	100.0
Homologous elements	156	48.5
Heterologous elements	93	28.9
Not classified	73	22.7
Morphology
Polypoid type	161	50.0
Non-polypoid type (broad base)	32	9.9
Not classified	129	38.9
DNA-ploidy
Diploid	51
Aneuploid (inclusive tetraploid)	87
Unknown	184
S-phase fraction
Mean	13.2 (95% CI 11.6–14.7)
Median	12.6 (range, 1.2–32.9)
Lymphovascular space invasion (LVSI)
Yes	55	16.6
No	277	83.4

Table II. Surgical technique used in the complete series.

	Number	Percent
Type of surgery
Radical hysterectomy	23	7.1
Total hysterectomy	220	68.3
Multiple excisions	33	10.3
No surgery	46	14.3
Lymph node dissection*
Yes	50	20.6
No	193	79.4

*Among patients who underwent primary surgery with hysterectomy or extended hysterectomy (Wertheim-technique), (n = 243).

Table III. Type of radiotherapy, targets and schedules used.

	Number	Percent
Type of radiotherapy
Postoperative	181	56.2
Preoperative	27 #	8.4
None	119	37.0
# Five of these 27 patients also received postoperative radiotherapy
Target
Pelvis (A-P or four-fields)	181	56.2
Intrauterine brachytherapy	27	8.4
Schedules*
1 × 2.0 Gy × 20	56	52.8
1 × 2.0 Gy × 23	30	28.3
1 × 2.0 Gy × 25	12	11.3
Other schedules	8	7.6

*The Örebro-series (n = 106).

Table IV. Sites of recurrences.

Site	Number	Percent
Vagina	22	6.8*
Pelvis	13	4.0
Abdomen	34	10.6
Liver	18	5.6
Lung	30	9.3
Lymph nodes	23	7.1
Bone	3	0.9
CNS	1	0.3
Central pelvic	34	27.6**
Regional	4	3.3
Distant metastases	89	72.4
Central pelvic + distant	4	3.3

*Percent of all patients included (n= 322); **Percent of all recurrences (n= 123).

Table V. Type of surgery and tumor recurrences.

Type of surgery	Number	Percent
Complete series (n= 322)
Radical hysterectomy	10/23	43.5
Simple hysterectomy	93/220	42.3
Explorative laparotomy	12/33	36.4
No surgery	8/46	17.4
Stage I–II (n= 169)
Radical hysterectomy	3/10	30.0
Simple hysterectomy	66/159	51.3

Table VI. Tumor recurrences versus radiotherapy in stages I–II.

Radiotherapy	Number	Percent
Complete series (n= 197)
All sites
Radiotherapy	57/142	40.1
No radiotherapy	20/55	36.4
		Pearson χ^2 = 0.238; p= 0.626
Locoregional sites
Radiotherapy	13/142	9.2
No radiotherapy	10/55	18.2
		Pearson χ^2 = 3.133; p= 0.077

Figure 1. The overall survival rate versus tumor stage in the complete series (n= 322).

Figure 2. The overall survival rate versus type of therapy (n= 322).

Figure 3. The locoregional recurrence-free survival rate versus type of therapy (n= 322).

Table VII. Radiation reactions.

	Number	Percent
Early radiation reactions*
Intestinal grade 1 (diarrhea)	58	54.7
Intestinal grade 2 (diarrhea with blood)	1	0.9
Late radiation reactions
Intestinal and/or bladder all grades*	20	18.9
Intestinal and/or bladder grade 3–4**	5	2.5
Radiation reactions and death***
Ileus and death during radiotherapy	1
Fistula and abdominal abscess	1
Small bowel perforation and peritonitis	1

*Data on the Örebro series (n = 106); **Data on the complete series (n = 204).

Table VIII. Cytotoxic side effects.

	Number	Percent
Chemotherapy treatment
Number of patients overall	92	28.6
Number of patients completing all cycles	62	67.4
Reason for treatment stop*
Bone marrow toxicity	5	5.4
Tumor progression	15	16.3
Deterioration of general well-being	12	13.0
Death due to chemotherapy	4	4.4

*In six patients more than one of the above mentioned reasons was present.