Efficacy and tolerability of combination cisplatin and ifosfamide chemotherapy with vaginal cuff brachytherapy in the first line treatment of uterine carcinosarcoma

Purpose of investigation: Aretrospective study to evaluate six cycles of cisplatin 40 mg/m2 on day 1 and ifosfamide 1,200 mg/m2 daily on days 1 to 4 with Mesna every four weeks as first line treatment for 29 patients with a diagnosis of uterine carcinosarcoma. Materials and Methods: A total of 23 of 29 patients received high dose rate intracavitary vaginal cuff brachytherapy (VCBT) with two fractions of seven Gy each. Median age was 65 years (range 40-82); 13 (44.8%) had Stage Ⅰ disease, three (10.3%) had Stage Ⅱ, eight (27.6%) had Stage Ⅲ, and five (17.2%) patients had Stage Ⅳ disease. Results: Most common toxicities were anemia grade 1 (35%)/grade 2 (45%), and neutropenia grade 3 (17%)/grade 4 (6.9%). Eleven dose modifications, four treatment discontinuations, and one patient withdrawal occurred. At a median follow up of 45 months (range 9 to 144 ), Progression free survival (PFS) was 20% and overall survival (OS) was 40% for Stage Ⅳ, PFS 75% and OS 62.5% for Stage Ⅲ, compared to a PFS 75 % and OS 72.2% for Stages Ⅰ- Ⅱ. Median OS for the entire group was 12.43 years (95% CI 3.69 to inf); for Stage Ⅰ-Ⅲ 12.4 years (6.1 to inf), and for Stage Ⅳ 15.6 months (95% CI 9.4 to inf). Conclusions: Cisplatin and ifosfamide chemotherapy with VCBT was well tolerated and has promising activity in uterine carcinosarcoma.

Cisplatin; Ifosfamide; Vaginal brachytherapy; Uterine carcinosarcoma.

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