Uterine Carcinosarcomas: A Single Center Experience

Yıl 2021, Cilt: 2 Sayı: 2, 82 - 88, 16.07.2021

Hacer Demir Meltem Baykara Sena Ece Davarcı Dağıstan Tolga Arıöz Cem Yağmur Özdemir İsmail Beypınar

https://doi.org/10.48176/esmj.2021.22

Öz

Introduction: Carcinosarcomas are aggressive tumors that can arise from any part of the gynecological tractus. Uterine carcinosarcomas also called Malign Mixed Mullerian tumors, are de-differentiated carcinomas with sarcomatous and carcinomatous components arising from a single clone and are among high-risk endometrial carcinomas due to the similarity of epidemiology and clinical features. They account for less than 5% of all uterine cancers. In our study, we evaluated the histopathological and clinical features of our patients who were followed up with the diagnosis of uterine carcinosarcoma in our clinic in the light of the literature.
Methods: We performed a retrospective analysis of 13 patients who were diagnosed with pathologically confirmed uterine carcinosarcoma. Patients were followed up and treated in the tertiary university hospital Medical Oncology outpatient clinic between 2015 and 2020. Demographic data of the patients, complaints at presentation, stages of diagnosis, surgery performed, chemotherapy and radiotherapy information, risk factors were retrospectively reviewed. Patients with missing follow-up data were excluded from the study.
Results: 13 patients were diagnosed with uterine carcinosarcoma and their mean age was 70.4 (58-83). All of the patients were in the postmenopausal period. Abnormal uterine bleeding was the most frequent complaint. Obesity was significantly frequent and median BMI was 33.27 (12.49-44.44) despite the absence of pelvic radiotherapy and tamoxifen as etiologic factors. Staging surgery was applied to all of our patients. After surgery, 11 patients received adjuvant chemotherapy and the most common adjuvant treatment protocol was Carboplatin-Paclitaxel combination (54%).
Conclusion: Uterine carcinosarcomas are rare and very aggressive tumors. Despite intensive combined treatments, the 5-year estimated survival in all patients is around 35 % and it is a disease with a high recurrence rate in addition to poor survival. Currently recommended first option treatment approach is surgical staging. Chemotherapy and radiotherapy are recommended to increase survival after surgery. Advanced treatment strategies are needed in the management of uterine carcinosarcoma patients. For this purpose, prospective studies including more patients are needed.

Anahtar Kelimeler

Malign Mixed Müllerian Tumor, carcinosarcoma, uterincarcinoma

Uterin Karsinosarkomlar: Tek Merkez Deneyimi

Öz

Giriş: Karsinosarkomlar jinekolojik sistemin herhangi bir bölgesinden kaynaklanabilen agresif tümörlerdir. Malign mikst müllerian tümör olarak da adlandırılan uterin karsinosarkomlar tek klondan kaynaklanan sarkomatöz ve karsinomatöz komponentleri olan de-diferansiye karsinomlar olup epidemiyolojileri ve klinik davranışlarının benzerliğinden dolayı yüksek riskli endometrial karsinomlar arasında yer almaktadır ve tüm uterin kanserlerin %5’den azını oluşturmaktadır. Çalışmamızda, kliniğimizde uterin karsinosarkom tanısı ile takip ettiğimiz hastaların literatür eşliğinde histopatolojik ve klinik özelliklerini değerlendirdik.
Yöntemler: Çalışmaya 2015-2020 tarihleri arasında üçüncü basamak üniversite hastanesi Tıbbi Onkoloji polikliniğinde takip ve tedavi edilen patolojik olarak konfirme edilmiş, uterin karsinosarkom tanılı, 18 yaş üstü, toplam 13 hasta dahil edildi. Hastaların demografik verileri, başvuru şikayetleri, tanı evreleri, yapılan cerrahi, aldıkları kemoterapi ve radyoterapi bilgileri, risk faktörleri retrospektif olarak dosya taraması yapılarak elde edildi. Yeterli takipleri olmayan ve dosya verilerine ulaşılamayan hastalar çalışma dışı bırakıldı.
Bulgular: Kliniğimizde uterin karsinosarkom tanısı ile takip ettiğimiz 13 hastanın yaş ortalaması 70,4 (58-83) olup, tamamı postmenopozal dönemdeydi. Hastaların en sık başvuru şekli anormal vajinal kanamaydı. Etyolojik faktörler içinde pelvik radyoterapi ve tamoksifen kullanımı bulunmazken obezite sıklığı belirgindi. Hastaların ortalama vücut kitle indeksi (BMI) 33,27 (12,49-44,44) idi. Hastalarımızın tamamına evreleme cerrahisi uygulanmış olup, en sık kullanılan cerrahi total histerektomi, bilateralsalpingo-ooferektomi ve lenf nodu diseksiyonuydu. Bununla birlikte, 11 hastaya ise cerrahi sonrası adjuvan kemoterapi uygulanmış olup, en sık uygulanan adjuvan tedavi protokolü karboplatin-paklitaksel kombinasyonu idi (%54).
Sonuç: Uterin karsinosarkomlar nadir görülen ve oldukça agresif seyreden tümörlerdir. Yoğun kombine tedavilere rağmen tüm hastalarda 5 yıllık tahmini sağkalım yaklaşık %35 olup hastalık yüksek rekürrens oranına ve kötü sağkalıma sahiptir. Günümüzde önerilen tedavi yaklaşımı ilk seçenek olarak cerrahi evreleme, sonrasında adjuvan kemoterapi (KT) ve radyoterapi (RT) uygulamaları olmaktadır. Uterin karsinosarkom hastalarının yönetiminde gelişmiş tedavi stratejilerine ihtiyaç duyulmaktadır. Bu amaçla hasta sayısının fazla olduğu prospektif çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

Malign mikst müllerian tümör, uterin karsinom, karsinosarkom

Kaynakça

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