Impact of radiotherapy modalities on outcomes in the adjuvant management of uterine carcinosarcoma: A National Cancer Database analysis

PurposeIn the postoperative management of uterine carcinosarcoma (UCS), the roles of individual radiotherapy (RT) modalities, chiefly external-beam radiotherapy (EBRT) and brachytherapy (BT), remain undefined. We analyzed the survival impact of EBRT and BT using the National Cancer Database.Methods and materialsWe abstracted women diagnosed with UCS from 2004 to 2012 who received hysterectomy and had complete RT information. Cox multivariate analysis and propensity-score matched analyses were used to compare survival among radiotherapeutic approaches.ResultsWe identified 1229 women receiving no radiotherapy, 472 receiving EBRT alone, 331 receiving BT alone, and 271 receiving EBRT+BT. On multivariate analysis of the entire analytic cohort, survival was significantly improved among patients receiving EBRT+BT combination (hazard ratio HR] 0.72, 95% confidence interval CI] = 0.58–0.89, p < 0.01), but not among those receiving EBRT alone (HR 0.93, 95% CI = 0.79–1.10, p = 0.41) or BT alone (HR 0.84, 95% CI = 0.68–1.03, p = 0.09). These results were confirmed on propensity-score matches for EBRT vs. no RT (HR 0.89, 95% CI = 0.73–1.07, p = 0.34), BT vs. no RT (HR 0.80, 95% CI = 0.63–1.03, p = 0.09), and EBRT+BT vs. no RT (HR 0.74, 95% CI = 0.58–0.96, p = 0.02).ConclusionsEBRT+BT combination is associated with an overall survival advantage in UCS and warrants consideration in the adjuvant management of this disease.