Gynecological Cancer

PV QA 4 - Poster Viewing Q&A 4

TU_13_3441 - Combined Modality Treatment of Sarcoma of the Cervix and Impact on Survival

Tuesday, October 23
2:45 PM - 4:15 PM
Location: Innovation Hub, Exhibit Hall 3

Combined Modality Treatment of Sarcoma of the Cervix and Impact on Survival
A. A. Albert1, R. M. Allbright2, and S. Vijayakumar3; 1Department of Radiation Oncology, University of Mississippi Medical Center, Jackson, MS, 2University of Mississippi Medical Center, Jackson, MS, 3Radiation Oncology, University of Mississippi Medical Center, Jackson, MS

Purpose/Objective(s): Primary sarcoma of the cervix is rare and is associated with worse outcomes as compared to more common histologies. The purpose of this study is to identify national treatment patterns and outcomes based on histological subtype and the impact of combined modality therapy on survival using the National Cancer Database (NCDB).

Materials/Methods: The National Cancer Database was queried for patients with cervical cancer from 2004-2015. Demographic, clinical, and treatment details were obtained and compared via the Chi Square test between patients with squamous cell carcinoma, adenocarcinoma, and sarcoma of the cervix. Univariable and multivariable Cox regression was used to determine variables associated with overall survival among all patients and among those with cervical sarcomas. Overall survival curves were generated using the Kaplan-Meier method.

Results: 107,177 patients met inclusion criteria including 81,245 (75.8%) women with squamous cell carcinoma, 24,562 (22.9%) women with adenocarcinoma, and 1,370 (1.3%) women with sarcoma. Of the patients with cervical sarcoma, 680 (49.6%) patients had carcinosarcoma or malignant mixed mullerian tumor, 255 (18.6%) patients had leiomyosarcoma, 197 (14.4%) patients had adenosarcoma, 28 (2.0%) patients had endometrial stromal sarcoma, 85 (6.2%) patients had rhabdomyosarcoma, and 125 (9.1%) patients had sarcoma not otherwise specified. Patients with sarcoma were older and more likely to be treated primarily with surgery. Five-year OS for all stages was 63.3% for squamous cell carcinoma, 73.7% for adenocarcinoma, and 47.7% for sarcoma (p<0.001). On multivariable Cox regression, patients with cervical sarcoma had decreased overall survival as compared to patients with squamous cell carcinoma (HR 2.17, 95% CI 1.99-2.37, p<0.001). Patients with cervical sarcoma who underwent operative management did not derive a significant benefit from adjuvant radiation (HR 0.90, 95% CI 0.60-1.35, p=0.612). On subgroup analysis, adjuvant radiation in patients with carcinosarcoma and positive pelvic lymph nodes resulted in increased 2-year OS, 62.3% versus 32.1% (p=0.019) and this survival benefit persisted on multivariable analysis (HR 0.08, 95% CI 0.01-0.76, p=0.027).

Conclusion: Primary cervical sarcomas have inferior outcomes compared to squamous cell carcinoma and adenocarcinoma. Adjuvant radiation was not associated with survival benefit except in patients with carcinomasarcoma and positive pelvic lymph nodes.

Author Disclosure: A.A. Albert: None. R.M. Allbright: None.

Ashley Albert, MD

Disclosure:
No relationships to disclose.

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