Clinical features and outcome in ovarian sarcomas:

Analysis of a single-institution experience

A López Pousa, X Gonzàlez Farré, MJ. Quintana, S Bagué, O Gallego, A Tibau, J Pérez, N Sala, JM.

Mazarico, V Artigas, A Barnadas

Background• Gynaecologic sarcomas are very uncommon tumours.

– Uterine sarcoma 3 – 6% of uterine malignancies.– Ovarian sarcoma Less than 1% of ovarian tumours.

• Most of them are carcinosarcoma.• Less than 400 cases reported in the literature.• Ovarian carcinosarcoma usually present with advanced

disease.• Survival seems to be worse than epithelial ovarian cancer.• Monoclonal theory:

– The epithelial component begins tumorigenesis.– Sarcomatous component is a metaplastic event during the

evolution.• Objective: To analyse their clinical features and outcome.

Methods

• We analysed retrospectively patients with ginaecologycal sarcomas treated at our institution between 1978 and 2007.

• Minimun follow-up 1 y.• Retrospective data

collection using medical charts.

• All the cases were reviewed by a single expert pathologist.

123 GS

100 GS23 excluded for:• Follow up < 1 y.• Missing data

13 ovarian sarcoma

87 uterine sarcoma

1 ovarian leyomiosarcoma

12 ovariancarcinosarcoma

Clinical features

• Median age: 63 years (45 – 77)

• Hormonal substitutive therapy in only 1 patient. (4 not known)

First symptom FIGO staging

Pathology

• Diagnosis: Hysterectomy or laparoscopic exploration.

Histologic grade

08%

92%

0

20

40

60

80

100

I II III

Tumor size

0

5

10

15

20

25

30

Treatment• All patients underwent total abdominal

hysterectomy and bilateral salpingoophorectomy.• Type of resection:

– 4 patients optimal cytoreduction – 8 patients suboptimal cytoreduction (including 1 stage IV

tumor)• Adjuvant chemotherapy:

– CDDP + Doxorubicine = 5– CYVADIC = 4– CBDCA – paclitaxel = 1– Ifosfamide = 1– Doxorubicine + Ifosfamide = 1

Platinum CT vs not: 6/6

Doxorubicine CT vs not: 10 vs 2

Results• Median Follow-up: 46 months• Nr of cycles: 6 (4-16)

• Relapsed patients: 7/11 ( 63 %)• Type Of Relapse:

– Local: 6/7– Distant + local 1/7

• Time To relapse: 48 (6-129) months• Treatment of relapsed disease

– Radical surgery + chemotherapy: 3/7 cases– Palliative chemoterapy: 4/7

Results: Overall survival

Results: Overall survival & stage

Results: Overall survival & Surgery

Results: Overall survival & CHT

Results: OS & relapse treatmentPt nr TTP Type of

surgeryPFS OS

1 11 Sugarbaker 18 22+

2 19 Peritonectomy / 8+

3 9 Peritonectomy+ LDN

/ 8+

Conclusions

• Due to the rarity of ovarian carcinosarcomas there are not prospective studies reported in the medical literature.

• The majority of retrospective analysis show that optimal surgery improves survival.

• The optimal chemotherapeutic regimen to treat this aggressive disease is yet to be determined. Most of the reviews recommend platinum based CTs.

Conclusions

• When feasible, aggressive approach for peritoneal recurrent disease should be considered.

• Prognosis of this infrequent disease seems to be worse than ovarian epithelial carcinoma, but in our series, probably due to the small number of cases, we have not found this result.