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Original Research

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

  • M.M. Abu-Khalaf1,*,
  • M.A. Raza2
  • C. Hatzis1
  • H. Wang3
  • K. Lin4
  • S. Higgins5
  • E. Ratner6
  • D.A. Silasi6
  • M. Azodi6
  • T.J. Rutherford6
  • A.D. Santin6
  • P.E. Schwartz6

1Section of Medical Oncology, Yale University School of Medicine, Yale Comprehensive Cancer Center, New Haven, CT, USA

2Regional Cancer Center, ProHealth Care Medical Associates, Milwaukee, WI, USA

3Department of Hematology and Oncology, Harvard Vanguard Medical Associates, Boston, MA, USA

4Department of Obstetrics & Gynecology, Division of Gynecologic Oncology, University Texas Southwestern Medical Center, Dallas, TX, USA

5Department of Therapeutic Radiology, Yale University School of Medicine, Yale Comprehensive Cancer Center, New Haven, CT, USA

6Department of Obstetrics, Gynecology &, Reproductive Sciences. Section of Gynecologic Oncology, Yale University School of Medicine, Yale Comprehensive Cancer Center, New Haven, CT, USA

DOI: 10.12892/ejgo2798.2016 Vol.37,Issue 2,April 2016 pp.199-203

Published: 10 April 2016

*Corresponding Author(s): M.M. Abu-Khalaf E-mail: maysa.abu-khalaf@yale.edu

Abstract

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.

Keywords

Cisplatin; Ifosfamide; Vaginal brachytherapy; Uterine carcinosarcoma.

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M.M. Abu-Khalaf,M.A. Raza,C. Hatzis,H. Wang,K. Lin,S. Higgins,E. Ratner,D.A. Silasi,M. Azodi,T.J. Rutherford,A.D. Santin,P.E. Schwartz. Efficacy and tolerability of combination cisplatin and ifosfamide chemotherapy with vaginal cuff brachytherapy in the first line treatment of uterine carcinosarcoma. European Journal of Gynaecological Oncology. 2016. 37(2);199-203.

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