Outcome and Predictive Factors in Uterine Carcinosarcoma Using Postoperative Radiotherapy: A Rare Cancer Network Study
Identifieur interne : 000634 ( Pmc/Curation ); précédent : 000633; suivant : 000635Outcome and Predictive Factors in Uterine Carcinosarcoma Using Postoperative Radiotherapy: A Rare Cancer Network Study
Auteurs : Daniel R. Zwahlen [Suisse, Australie] ; Ulrike Schick ; Yasemin Bolukbasi [Turquie] ; Juliette Thariat [France] ; Roxolyana Abdah-Bortnyak [Israël] ; Abraham Kuten [Israël] ; Sefik Igdem [Turquie] ; Hale Caglar [Turquie] ; Zeynep Ozsaran [Turquie] ; Kristina Loessl [Suisse] ; Kaouthar Khanfir Belkaaloul [Suisse] ; Sylviane Villette [France] ; Hansjörg VeesSource :
- Rare Tumors [ 2036-3605 ] ; 2016.
Abstract
Uterine carcinosarcomas (UCS) are rare tumors. Consensus regarding therapeutic management in non-metastatic disease is lacking. This study reports on outcome and predictive factors when using postoperative radiotherapy. We analyzed a retrospective analysis in 124 women treated between 1987-2007 in the framework of the Rare-Cancer-Network. Median follow-up was 27 months. Postoperative pelvic EBRT was administered in 105 women (85%) and 92 patients (74%) received exclusive or additional vaginal brachytherapy. Five-year overall survival (OS), disease-free survival (DFS), cancer specific survival (CSS) and locoregional control (LRC) were 51.6% (95% CI 35-73%), 53.7% (39-71%), 58.6% (38-74%) and 48% (38-67%). Multivariate analysis showed that external beam radiation therapy (EBRT) >50Gy was an independent prognostic factor for better OS (P=0.03), CSS (P=0.02) and LRC (P=0.01). Relative risks (RR) for better OS (P=0.02), DFS (P=0.04) and LRC (P=0.01) were significantly associated with younger age (≤60 years). Higher brachytherapy (BT)-dose (>9Gy) improved DFS (P=0.04) and LRC (P=0.008). We concluded that UCS has high systemic failure rate. Local relapse was reduced by a relative risk factor of over three in all stages of diseases when using higher doses for EBRT and brachytherapy. Postoperative RT was most effective in UCS stage I/II-diseases.
Url:
DOI: 10.4081/rt.2016.6052
PubMed: 27441069
PubMed Central: 4935818
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<front><div type="abstract" xml:lang="en"><p>Uterine carcinosarcomas (UCS) are rare tumors. Consensus regarding therapeutic management in non-metastatic disease is lacking. This study reports on outcome and predictive factors when using postoperative radiotherapy. We analyzed a retrospective analysis in 124 women treated between 1987-2007 in the framework of the Rare-Cancer-Network. Median follow-up was 27 months. Postoperative pelvic EBRT was administered in 105 women (85%) and 92 patients (74%) received exclusive or additional vaginal brachytherapy. Five-year overall survival (OS), disease-free survival (DFS), cancer specific survival (CSS) and locoregional control (LRC) were 51.6% (95% CI 35-73%), 53.7% (39-71%), 58.6% (38-74%) and 48% (38-67%). Multivariate analysis showed that external beam radiation therapy (EBRT) >50Gy was an independent prognostic factor for better OS (P=0.03), CSS (P=0.02) and LRC (P=0.01). Relative risks (RR) for better OS (P=0.02), DFS (P=0.04) and LRC (P=0.01) were significantly associated with younger age (≤60 years). Higher brachytherapy (BT)-dose (>9Gy) improved DFS (P=0.04) and LRC (P=0.008). We concluded that UCS has high systemic failure rate. Local relapse was reduced by a relative risk factor of over three in all stages of diseases when using higher doses for EBRT and brachytherapy. Postoperative RT was most effective in UCS stage I/II-diseases.</p>
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<pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Rare Tumors</journal-id>
<journal-id journal-id-type="iso-abbrev">Rare Tumors</journal-id>
<journal-id journal-id-type="publisher-id">RT</journal-id>
<journal-title-group><journal-title>Rare Tumors</journal-title>
</journal-title-group>
<issn pub-type="ppub">2036-3605</issn>
<issn pub-type="epub">2036-3613</issn>
<publisher><publisher-name>PAGEPress Publications, Pavia, Italy</publisher-name>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">27441069</article-id>
<article-id pub-id-type="pmc">4935818</article-id>
<article-id pub-id-type="doi">10.4081/rt.2016.6052</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Article</subject>
</subj-group>
</article-categories>
<title-group><article-title>Outcome and Predictive Factors in Uterine Carcinosarcoma Using Postoperative Radiotherapy: A Rare Cancer Network Study</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Zwahlen</surname>
<given-names>Daniel R.</given-names>
</name>
<xref ref-type="aff" rid="aff001"><sup>1</sup>
</xref>
<xref ref-type="aff" rid="aff002"><sup>2</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Schick</surname>
<given-names>Ulrike</given-names>
</name>
<xref ref-type="aff" rid="aff003"><sup>3</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Bolukbasi</surname>
<given-names>Yasemin</given-names>
</name>
<xref ref-type="aff" rid="aff004"><sup>4</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Thariat</surname>
<given-names>Juliette</given-names>
</name>
<xref ref-type="aff" rid="aff005"><sup>5</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Abdah-Bortnyak</surname>
<given-names>Roxolyana</given-names>
</name>
<xref ref-type="aff" rid="aff006"><sup>6</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Kuten</surname>
<given-names>Abraham</given-names>
</name>
<xref ref-type="aff" rid="aff006"><sup>6</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Igdem</surname>
<given-names>Sefik</given-names>
</name>
<xref ref-type="aff" rid="aff007"><sup>7</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Caglar</surname>
<given-names>Hale</given-names>
</name>
<xref ref-type="aff" rid="aff008"><sup>8</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Ozsaran</surname>
<given-names>Zeynep</given-names>
</name>
<xref ref-type="aff" rid="aff004"><sup>4</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Loessl</surname>
<given-names>Kristina</given-names>
</name>
<xref ref-type="aff" rid="aff009"><sup>9</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Belkaaloul</surname>
<given-names>Kaouthar Khanfir</given-names>
</name>
<xref ref-type="aff" rid="aff010"><sup>10</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Villette</surname>
<given-names>Sylviane</given-names>
</name>
<xref ref-type="aff" rid="aff011"><sup>11</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Vees</surname>
<given-names>Hansjörg</given-names>
</name>
<xref ref-type="aff" rid="aff003"><sup>3</sup>
</xref>
<xref ref-type="corresp" rid="cor1"></xref>
</contrib>
</contrib-group>
<aff id="aff001"><label>1</label>
Department of Radiation Oncology,<institution>Kantonsspital Graubuenden</institution>
,<addr-line>Chur, Switzerland</addr-line>
</aff>
<aff id="aff002"><label>2</label>
Department of Radiation Oncology,<institution>William Buckland Radiotherapy Centre, Alfred Health</institution>
,<addr-line>Melbourne, Australia</addr-line>
</aff>
<aff id="aff003"><label>3</label>
Department of Radiation Oncology,<institution>University Hospital Geneva</institution>
,<addr-line>Switzerland</addr-line>
</aff>
<aff id="aff004"><label>4</label>
Department of Radiation Oncology,<institution>Ege University Hospital</institution>
,<addr-line>Izmir, Turkey</addr-line>
</aff>
<aff id="aff005"><label>5</label>
Department of Radiation Oncology,<institution>Antoine Lacassagne Center</institution>
,<addr-line>Nice, France</addr-line>
</aff>
<aff id="aff006"><label>6</label>
Department of Radiation Oncology,<institution>Rambam Medical Center</institution>
,<addr-line>Haifa, Israel</addr-line>
</aff>
<aff id="aff007"><label>7</label>
Department of Radiation Oncology,<institution>Metropolitan Hospital</institution>
,<addr-line>Istanbul, Turkey</addr-line>
</aff>
<aff id="aff008"><label>8</label>
Department of Radiation Oncology,<institution>Marmara University Hospital</institution>
,<addr-line>Istanbul, Turkey</addr-line>
</aff>
<aff id="aff009"><label>9</label>
Department of Radiation Oncology,<institution>University Hospital</institution>
,<addr-line>Bern, Switzerland</addr-line>
</aff>
<aff id="aff010"><label>10</label>
Department of Radiation Oncology,<institution>Hôpital du Valais</institution>
,<addr-line>Sion, Switzerland</addr-line>
</aff>
<aff id="aff011"><label>11</label>
Department of Radiation Oncology,<institution>René Huguenin Center</institution>
,<addr-line>Saint-Cloud, France</addr-line>
</aff>
<author-notes><corresp id="cor1">Institute for Radiotherapy, Hirslanden Klinik, Witellikerstrasse 40, CH-8032 Zürich, Switzerland. <phone>+41.44.9224410</phone>
- <fax>+41.44.9224423</fax>
. <email>hansjoerg.vees@hirslanden.ch</email>
</corresp>
<fn fn-type="con"><p>Contributions: DRZ, data collection, data analysis and article writing; US, data collection and data analysis; YB, JT, RAB, AK, SI, HC, ZO, KL, KKB, and SV, data collection; HV, data analysis, statistics and article writing. DRZ and HV contributed equally to this publication</p>
</fn>
<fn fn-type="conflict"><p>Conflict of interest: the authors declare no potential conflict of interest.</p>
</fn>
</author-notes>
<pub-date pub-type="epub"><day>29</day>
<month>6</month>
<year>2016</year>
</pub-date>
<pub-date pub-type="collection"><day>28</day>
<month>6</month>
<year>2016</year>
</pub-date>
<volume>8</volume>
<issue>2</issue>
<elocation-id>6052</elocation-id>
<history><date date-type="received"><day>08</day>
<month>6</month>
<year>2015</year>
</date>
<date date-type="rev-recd"><day>06</day>
<month>8</month>
<year>2015</year>
</date>
<date date-type="accepted"><day>07</day>
<month>8</month>
<year>2015</year>
</date>
</history>
<permissions><copyright-statement>©Copyright D.R. Zwahlen et al.</copyright-statement>
<copyright-year>2016</copyright-year>
<copyright-holder>Licensee PAGEPress, Italy</copyright-holder>
<license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/"><license-p>This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (<uri xlink:href="http://creativecommons.org/licenses/by-nc/3.0/">http://creativecommons.org/licenses/by-nc/3.0/</uri>
) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p>
</license>
</permissions>
<abstract><p>Uterine carcinosarcomas (UCS) are rare tumors. Consensus regarding therapeutic management in non-metastatic disease is lacking. This study reports on outcome and predictive factors when using postoperative radiotherapy. We analyzed a retrospective analysis in 124 women treated between 1987-2007 in the framework of the Rare-Cancer-Network. Median follow-up was 27 months. Postoperative pelvic EBRT was administered in 105 women (85%) and 92 patients (74%) received exclusive or additional vaginal brachytherapy. Five-year overall survival (OS), disease-free survival (DFS), cancer specific survival (CSS) and locoregional control (LRC) were 51.6% (95% CI 35-73%), 53.7% (39-71%), 58.6% (38-74%) and 48% (38-67%). Multivariate analysis showed that external beam radiation therapy (EBRT) >50Gy was an independent prognostic factor for better OS (P=0.03), CSS (P=0.02) and LRC (P=0.01). Relative risks (RR) for better OS (P=0.02), DFS (P=0.04) and LRC (P=0.01) were significantly associated with younger age (≤60 years). Higher brachytherapy (BT)-dose (>9Gy) improved DFS (P=0.04) and LRC (P=0.008). We concluded that UCS has high systemic failure rate. Local relapse was reduced by a relative risk factor of over three in all stages of diseases when using higher doses for EBRT and brachytherapy. Postoperative RT was most effective in UCS stage I/II-diseases.</p>
</abstract>
<kwd-group><title>Key words</title>
<kwd>Carcinosarcoma</kwd>
<kwd>uterine malignancies</kwd>
<kwd>radiotherapy</kwd>
<kwd>brachytherapy</kwd>
<kwd>toxicity</kwd>
</kwd-group>
<counts><fig-count count="1"></fig-count>
<table-count count="3"></table-count>
<equation-count count="0"></equation-count>
<ref-count count="30"></ref-count>
<page-count count="7"></page-count>
</counts>
</article-meta>
</front>
<floats-group><fig id="fig001" orientation="portrait" position="float"><label>Figure 1.</label>
<caption><p>Five-year overall survival rates (A) and disease-free survival rates (B) in patients presenting with uterine carcinosarcoma.</p>
</caption>
<graphic xlink:href="rt-2016-2-6052-g001"></graphic>
</fig>
<table-wrap id="table001" orientation="portrait" position="float"><label>Table 1.</label>
<caption><p>Patient, tumor and treatment characteristics.</p>
</caption>
<table frame="box" rules="all"><thead><tr><th align="left" valign="top" rowspan="1" colspan="1">Characteristic</th>
<th align="center" valign="top" rowspan="1" colspan="1">N=124</th>
</tr>
</thead>
<tbody><tr><td align="left" valign="top" rowspan="1" colspan="1">Age years, median (range)</td>
<td align="center" valign="top" rowspan="1" colspan="1">66.5 (50-88)</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1">Postmenopausal status</td>
<td align="center" valign="top" rowspan="1" colspan="1">116(94)</td>
</tr>
<tr><td align="left" valign="top" colspan="2" rowspan="1">Symptoms at diagnosis</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> Bleeding</td>
<td align="center" valign="top" rowspan="1" colspan="1">102(82)</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> Pain</td>
<td align="center" valign="top" rowspan="1" colspan="1">18(15)</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> Tamoxifen intake history</td>
<td align="center" valign="top" rowspan="1" colspan="1">17(14)</td>
</tr>
<tr><td align="left" valign="top" colspan="2" rowspan="1">FIGO Stage (2009)</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> IA</td>
<td align="center" valign="top" rowspan="1" colspan="1">38(30)</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> IB</td>
<td align="center" valign="top" rowspan="1" colspan="1">26(21)</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> II</td>
<td align="center" valign="top" rowspan="1" colspan="1">17(14)</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> All stage I/II</td>
<td align="center" valign="top" rowspan="1" colspan="1">81(65)</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> IIIA</td>
<td align="center" valign="top" rowspan="1" colspan="1">17(14)</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> IIIB</td>
<td align="center" valign="top" rowspan="1" colspan="1">3(2)</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> IIIC</td>
<td align="center" valign="top" rowspan="1" colspan="1">15(12)</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> IV</td>
<td align="center" valign="top" rowspan="1" colspan="1">4(3)</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> All stage III/IV</td>
<td align="center" valign="top" rowspan="1" colspan="1">39(32)</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> Unknown</td>
<td align="center" valign="top" rowspan="1" colspan="1">4(3)</td>
</tr>
<tr><td align="left" valign="top" colspan="2" rowspan="1">Surgery</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> Hysterectomy</td>
<td align="center" valign="top" rowspan="1" colspan="1">124</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> Salpingo-oophorectomy</td>
<td align="center" valign="top" rowspan="1" colspan="1">122(98)</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> Pelvic nodal evaluation</td>
<td align="center" valign="top" rowspan="1" colspan="1">76(61)</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> Positive margin</td>
<td align="center" valign="top" rowspan="1" colspan="1">12(9) [20 pts without info concerning margins]</td>
</tr>
<tr><td align="left" valign="top" colspan="2" rowspan="1">Radiation therapy</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> No adjuvant RT</td>
<td align="center" valign="top" rowspan="1" colspan="1">13(10)</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> Adjuvant RT</td>
<td align="center" valign="top" rowspan="1" colspan="1">111(90)</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> EBRT only</td>
<td align="center" valign="top" rowspan="1" colspan="1">19(15)</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> EBRT+BT</td>
<td align="center" valign="top" rowspan="1" colspan="1">86(69)</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> BT only</td>
<td align="center" valign="top" rowspan="1" colspan="1">6(3)</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1">Interruption >5 days</td>
<td align="center" valign="top" rowspan="1" colspan="1">14(11)</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1">Mean EBRT dose (Gy)</td>
<td align="center" valign="top" rowspan="1" colspan="1">48.4 (range, 9-59 Gy, median 50.4 Gy)</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1">Mean BT dose (Gy)</td>
<td align="center" valign="top" rowspan="1" colspan="1">16.1 (range, 6-34 Gy, median 16.0 Gy)</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1">Adjuvant chemotherapy</td>
<td align="center" valign="top" rowspan="1" colspan="1">25(20)</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1">Hormonal treatment</td>
<td align="center" valign="top" rowspan="1" colspan="1">13(10)</td>
</tr>
</tbody>
</table>
<table-wrap-foot><fn><p>FIGO, International Federation of Gynecology and Obstetrics; RT, Radiation therapy; EBRT, External beam radiation therapy; BT, Brachytherapy; pts, Patients. Values are numbers (percentage) unless otherwise noted.</p>
</fn>
</table-wrap-foot>
</table-wrap>
<table-wrap id="table002" orientation="portrait" position="float"><label>Table 2.</label>
<caption><p>Analysis of predictive factors for overall survival, cancer-specific survival, disease-free survival and locoregional control.</p>
</caption>
<table frame="box" rules="all"><thead><tr><th align="left" valign="top" rowspan="1" colspan="1">5-year outcome</th>
<th align="center" valign="top" rowspan="1" colspan="1">OS 51.6%<break></break>
(95%CI 35-73%)</th>
<th align="center" valign="top" rowspan="1" colspan="1">CSS 58.6%<break></break>
(95%CI 38-74%)</th>
<th align="center" valign="top" rowspan="1" colspan="1">DFS 53.7%<break></break>
(95%CI 39-71%)</th>
<th align="center" valign="top" rowspan="1" colspan="1">LRC 48.0%<break></break>
(95%CI 38-67%)</th>
</tr>
</thead>
<tbody><tr><td align="left" valign="top" colspan="5" rowspan="1">Multivariate analysis, P-value (RR)</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> PLND</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.08 (1.9)</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.03 (2.6)</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.03 (2.3)</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.05 (2.0)</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> Dose EBRT >50 Gy</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.03 (2.5)</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.02 (2.2)</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.06 (1.8)</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.01 (3.6)</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> Dose BT ≤9Gy <italic>vs</italic>
. ≥9Gy</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.1 (1.5)</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.08 (1.7)</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.04 (2.1)</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.008 (5.1)</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> FIGO stage I-II <italic>vs</italic>
. III-IV</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.01 (3.3)</td>
<td align="center" valign="top" rowspan="1" colspan="1">-</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.03 (2.4)</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.07 (1.7)</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> Age ≤60 <italic>vs.</italic>
≥ 60 years</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.02 (3.9)</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.05 (1.7)</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.04 (2.2)</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.01 (4.3)</td>
</tr>
<tr><td align="left" valign="top" colspan="5" rowspan="1">Univariate analysis %, P value (95 CI)</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> Chemotherapy</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.15 (24-79)</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.64 (33-81)</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.29 (38-70)</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.23 (34-71)</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> PLND</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.1 (36-73)</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.01 (31-77)</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.02 (33-72)</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.01 (26-63)</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> Dose Brachytherapy</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.01 (32-76)</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.04 (36-75)</td>
<td align="center" valign="top" rowspan="1" colspan="1"><0.001 (36-71)</td>
<td align="center" valign="top" rowspan="1" colspan="1"><0.001 (30-76)</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> Surgical resection margin</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.32 (27-84)</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.17 (30-76)</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.39 (37-74)</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.28 (36-69)</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> Pelvic lymph node RT</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.42 (37-76)</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.61 (30-69)</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.56 (37-70)</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.12 (29-72)</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> RT treatment interruption >5 days</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.45 (38-81)</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.72 (37-80)</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.68 (36-71)</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.22 (38-81)</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> EBRT</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.91 (38-74)</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.82 (34-76)</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.88 (38-73)</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.76 (23-73)</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> Premenopausal status</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.14 (29-74)</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.20 (26-77)</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.10 (37-70)</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.12 (34-71)</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> Dose postoperative RT</td>
<td align="center" valign="top" rowspan="1" colspan="1"><0.001 (30-71)</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.009 (32-79)</td>
<td align="center" valign="top" rowspan="1" colspan="1"><0.001 (34-62)</td>
<td align="center" valign="top" rowspan="1" colspan="1"><0.001 (23-66)</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> Stage I/II <italic>vs.</italic>
III/IV</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.04 (30-76)</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.05 (28-75)</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.04 (32-68)</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.04 (31-70)</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1"> Age at diagnosis</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.02 (33-74)</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.04 (27-78)</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.01 (36-63)</td>
<td align="center" valign="top" rowspan="1" colspan="1">0.02 (34-67)</td>
</tr>
</tbody>
</table>
<table-wrap-foot><fn><p>OS, overall survival; CSS, cancer-specific survival; DFS, disease-free survival; LRC, locoregional control; RR, relative risk; PLND, pelvic lymph node dissection; CI, confidence interval; Other abbreviations as in <xref ref-type="table" rid="table001">Table 1</xref>
.</p>
</fn>
</table-wrap-foot>
</table-wrap>
<table-wrap id="table003" orientation="portrait" position="float"><label>Table 3.</label>
<caption><p>Selected studies reporting outcome and prognostic factors in uterine carcinosarcomas.</p>
</caption>
<table frame="box" rules="all"><thead><tr><th align="left" valign="top" rowspan="1" colspan="1">Author/year</th>
<th align="left" valign="top" rowspan="1" colspan="1">Year, n.</th>
<th align="left" valign="top" rowspan="1" colspan="1">Median age, y</th>
<th align="left" valign="top" rowspan="1" colspan="1">FIGO stage</th>
<th align="left" valign="top" rowspan="1" colspan="1">Positive surgical margin</th>
<th align="left" valign="top" rowspan="1" colspan="1">Median FU, months</th>
<th align="left" valign="top" rowspan="1" colspan="1">LAD</th>
<th align="left" valign="top" rowspan="1" colspan="1">Adjuvant treatment</th>
<th align="left" valign="top" rowspan="1" colspan="1"><break></break>
OS</th>
<th align="left" valign="top" rowspan="1" colspan="1"><break></break>
DFS</th>
<th align="left" valign="top" rowspan="1" colspan="1"><break></break>
CSS</th>
<th align="left" valign="top" rowspan="1" colspan="1"><break></break>
LRC</th>
<th align="left" valign="top" rowspan="1" colspan="1">Outcome factors</th>
</tr>
<tr><th align="left" valign="top" colspan="13" rowspan="1">Randomized prospective studies</th>
</tr>
</thead>
<tbody><tr><td align="left" valign="top" rowspan="1" colspan="1">Reed 2008<sup><xref rid="ref12" ref-type="bibr">12</xref>
</sup>
</td>
<td align="left" valign="top" rowspan="1" colspan="1">1988-2001. 92/224</td>
<td align="left" valign="top" rowspan="1" colspan="1">59 whole study population</td>
<td align="left" valign="top" rowspan="1" colspan="1">NR tor subgroup UCS (98.2% of whole study population had stage 1 and 11)</td>
<td align="left" valign="top" rowspan="1" colspan="1">NR</td>
<td align="left" valign="top" rowspan="1" colspan="1">81.6 (whole study population)</td>
<td align="left" valign="top" rowspan="1" colspan="1">NR for subgroup UCS (74.1% of whole study population had no LAD)</td>
<td align="left" valign="top" rowspan="1" colspan="1">Randomized: RT: 47 pts, No RT: 45 pts</td>
<td align="left" valign="top" rowspan="1" colspan="1">5y: whole study population median survival time (y): RT: 8.53; No RT: 6.78; n.s.</td>
<td align="left" valign="top" rowspan="1" colspan="1">5y: whole study population RT:51% No RT: 49%; n.s.</td>
<td align="left" valign="top" rowspan="1" colspan="1">NR</td>
<td align="left" valign="top" rowspan="1" colspan="1">5y: RT:61% No RT: 47%</td>
<td align="left" valign="top" rowspan="1" colspan="1">NR</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1">Wolfson 2007<sup><xref rid="ref11" ref-type="bibr">11</xref>
</sup>
</td>
<td align="left" valign="top" rowspan="1" colspan="1">1993-2005, 206</td>
<td align="left" valign="top" rowspan="1" colspan="1">68</td>
<td align="left" valign="top" rowspan="1" colspan="1">I:31%, II:13%, III: 45%, IV: 12%</td>
<td align="left" valign="top" rowspan="1" colspan="1">5.0% (gross residual disease)</td>
<td align="left" valign="top" rowspan="1" colspan="1">5.3</td>
<td align="left" valign="top" rowspan="1" colspan="1">NR RT</td>
<td align="left" valign="top" rowspan="1" colspan="1">Randomized: (whole abdominial irradiation): 105 pts, No RT (but ChT): 101 pts</td>
<td align="left" valign="top" rowspan="1" colspan="1">5y: RT: 35%; No RT: 45%; n.s.</td>
<td align="left" valign="top" rowspan="1" colspan="1">5y: RT:42%, No RT: 48%</td>
<td align="left" valign="top" rowspan="1" colspan="1">NR</td>
<td align="left" valign="top" rowspan="1" colspan="1">NR</td>
<td align="left" valign="top" rowspan="1" colspan="1">NR</td>
</tr>
<tr><td align="left" valign="top" colspan="13" rowspan="1"><bold>Retrospective studies</bold>
</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1">Vongtama 1976<sup><xref rid="ref19" ref-type="bibr">19</xref>
</sup>
</td>
<td align="left" valign="top" rowspan="1" colspan="1">1945-1972, 27/115</td>
<td align="left" valign="top" rowspan="1" colspan="1">58 (mean) whole study population</td>
<td align="left" valign="top" rowspan="1" colspan="1">I:81%, II:19%</td>
<td align="left" valign="top" rowspan="1" colspan="1">NR</td>
<td align="left" valign="top" rowspan="1" colspan="1">NR</td>
<td align="left" valign="top" rowspan="1" colspan="1">NR</td>
<td align="left" valign="top" rowspan="1" colspan="1">Sx:10 pts;Sx + RT: 14 pts; RT alone: 3 pts</td>
<td align="left" valign="top" rowspan="1" colspan="1">5y Sx:36% Sx+RT: 57%; RT alone: 0%</td>
<td align="left" valign="top" rowspan="1" colspan="1">NR</td>
<td align="left" valign="top" rowspan="1" colspan="1">NR</td>
<td align="left" valign="top" rowspan="1" colspan="1">NR</td>
<td align="left" valign="top" rowspan="1" colspan="1">Adjuvant RT for OS</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1">Major 1993<sup><xref rid="ref18" ref-type="bibr">18</xref>
</sup>
</td>
<td align="left" valign="top" rowspan="1" colspan="1">1979-1988, 301/453</td>
<td align="left" valign="top" rowspan="1" colspan="1">66</td>
<td align="left" valign="top" rowspan="1" colspan="1">I:59%, II:21%, III: 9%, IV: 11%</td>
<td align="left" valign="top" rowspan="1" colspan="1">NR</td>
<td align="left" valign="top" rowspan="1" colspan="1">NR</td>
<td align="left" valign="top" rowspan="1" colspan="1">95%</td>
<td align="left" valign="top" rowspan="1" colspan="1">Sx: 182 pts; Sx + RT: 119 pts</td>
<td align="left" valign="top" rowspan="1" colspan="1">NR</td>
<td align="left" valign="top" rowspan="1" colspan="1">NR</td>
<td align="left" valign="top" rowspan="1" colspan="1">NR</td>
<td align="left" valign="top" rowspan="1" colspan="1">Crude rate, Sx: 43 pts, Rx+RT: 20 pts</td>
<td align="left" valign="top" rowspan="1" colspan="1">Progression-tree survival: Lymph adnexal involvement, histologic grade of sarcoma</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1">Sartori 1997<sup><xref rid="ref30" ref-type="bibr">30</xref>
</sup>
</td>
<td align="left" valign="top" rowspan="1" colspan="1">1980-1994, 118</td>
<td align="left" valign="top" rowspan="1" colspan="1">67</td>
<td align="left" valign="top" rowspan="1" colspan="1">I:47%, II:9%, III: 23.5%, IV: 18% No Sx: 2.5%</td>
<td align="left" valign="top" rowspan="1" colspan="1">NR</td>
<td align="left" valign="top" rowspan="1" colspan="1">66</td>
<td align="left" valign="top" rowspan="1" colspan="1">40%</td>
<td align="left" valign="top" rowspan="1" colspan="1">FIGO stage 1/11; Sx + RT: 28 pts; Sx: 33 pts; Sx + ChT: 5 pts</td>
<td align="left" valign="top" rowspan="1" colspan="1">NR</td>
<td align="left" valign="top" rowspan="1" colspan="1">5y: Sx+RT: 53% Sx: 50%, n.s.</td>
<td align="left" valign="top" rowspan="1" colspan="1">NR</td>
<td align="left" valign="top" rowspan="1" colspan="1">At closure of study 59%</td>
<td align="left" valign="top" rowspan="1" colspan="1">Sx</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1">Brown 2015<sup><xref rid="ref15" ref-type="bibr">15</xref>
</sup>
</td>
<td align="left" valign="top" rowspan="1" colspan="1">2000-2013, 33</td>
<td align="left" valign="top" rowspan="1" colspan="1">68</td>
<td align="left" valign="top" rowspan="1" colspan="1">I:97%, II:3%</td>
<td align="left" valign="top" rowspan="1" colspan="1">NR</td>
<td align="left" valign="top" rowspan="1" colspan="1">24</td>
<td align="left" valign="top" rowspan="1" colspan="1">Pelvis: 82%, para-aortic: 42%</td>
<td align="left" valign="top" rowspan="1" colspan="1">BT: 100%; ChT: 55%</td>
<td align="left" valign="top" rowspan="1" colspan="1">2y: 79%</td>
<td align="left" valign="top" rowspan="1" colspan="1">66%</td>
<td align="left" valign="top" rowspan="1" colspan="1">NR</td>
<td align="left" valign="top" rowspan="1" colspan="1">81%</td>
<td align="left" valign="top" rowspan="1" colspan="1">NR</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1">Patel 2015<sup><xref rid="ref13" ref-type="bibr">13</xref>
</sup>
</td>
<td align="left" valign="top" rowspan="1" colspan="1">1998-2010, 1581</td>
<td align="left" valign="top" rowspan="1" colspan="1"><55:12.7%, 55-64:32%, 65-75:30.8% 75+: 24.5%</td>
<td align="left" valign="top" rowspan="1" colspan="1">I:86.7%, II:13.3%</td>
<td align="left" valign="top" rowspan="1" colspan="1">NR</td>
<td align="left" valign="top" rowspan="1" colspan="1">NR</td>
<td align="left" valign="top" rowspan="1" colspan="1">NR</td>
<td align="left" valign="top" rowspan="1" colspan="1">Sx: 50.8%; Sx + EBRT ± BT: 40.2% Sx + BT alone: 9%</td>
<td align="left" valign="top" rowspan="1" colspan="1">NR</td>
<td align="left" valign="top" rowspan="1" colspan="1">NR</td>
<td align="left" valign="top" rowspan="1" colspan="1">NR</td>
<td align="left" valign="top" rowspan="1" colspan="1">NR</td>
<td align="left" valign="top" rowspan="1" colspan="1">higher rates of OS and CSS:younger age at diagnosis. FIGOI (vs. II)</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1">Harano 2015<sup><xref rid="ref14" ref-type="bibr">14</xref>
</sup>
</td>
<td align="left" valign="top" rowspan="1" colspan="1">2007-2012, 486</td>
<td align="left" valign="top" rowspan="1" colspan="1">65</td>
<td align="left" valign="top" rowspan="1" colspan="1">I:46%, II:7%, III: 28%, IV: 19%</td>
<td align="left" valign="top" rowspan="1" colspan="1">Residual tumor <1 cm: 87%, >1 cm: 11%, unknown: 2%</td>
<td align="left" valign="top" rowspan="1" colspan="1">23.1</td>
<td align="left" valign="top" rowspan="1" colspan="1">Pelvis: 56%, Para-aortic: 23%</td>
<td align="left" valign="top" rowspan="1" colspan="1">Sx + ChT: 91%; Sx + RT: 2%; Sx + RT/ChT: 1%; Observation: 6%</td>
<td align="left" valign="top" rowspan="1" colspan="1">5y: whole study population 53.6%; I:69.9%, II:64.4%,III:43.5%, IV: 25.3%</td>
<td align="left" valign="top" rowspan="1" colspan="1">5y: whole study population 40.4%, I:59.4%, II:52.4%, III:25.6%, IV: 12.3%</td>
<td align="left" valign="top" rowspan="1" colspan="1">NR</td>
<td align="left" valign="top" rowspan="1" colspan="1">NR</td>
<td align="left" valign="top" rowspan="1" colspan="1">Poor prognosis: Stage, performance status, CA-125 level, Lymphovascular invasion, myometrial invasion, Good prognosis: pelvic LAD</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1">Livi 2003<sup><xref rid="ref17" ref-type="bibr">17</xref>
</sup>
</td>
<td align="left" valign="top" rowspan="1" colspan="1">1974-2001, 42/141</td>
<td align="left" valign="top" rowspan="1" colspan="1">56</td>
<td align="left" valign="top" rowspan="1" colspan="1">NR tor subgroup UCS. I:50.5%, II:9%, III: 22%, IV: 18.5%</td>
<td align="left" valign="top" rowspan="1" colspan="1">NR</td>
<td align="left" valign="top" rowspan="1" colspan="1">36</td>
<td align="left" valign="top" rowspan="1" colspan="1">Not performed in any patient</td>
<td align="left" valign="top" rowspan="1" colspan="1">Whole study population: Sx: 25.5%; Sx + RT: 52.5%</td>
<td align="left" valign="top" rowspan="1" colspan="1">NR</td>
<td align="left" valign="top" rowspan="1" colspan="1">5y: with stage I: Sx: 15%, Sx + ChT: 43% Sx + RT: 70% with stage III, Sx: 40%, Sx + RT + BT: 85.8%</td>
<td align="left" valign="top" rowspan="1" colspan="1">5y: NR for UCS; whole study population 27.7%</td>
<td align="left" valign="top" rowspan="1" colspan="1">3y: Sx:38%; Sx + RT: 69% Sx + RT + BT: 72%, Sx + ChT: 29%</td>
<td align="left" valign="top" rowspan="1" colspan="1">Stage, histology adjuvant RT >50 Gy (P=0.001)</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1">Callister 2004<sup><xref rid="ref6" ref-type="bibr">6</xref>
</sup>
</td>
<td align="left" valign="top" rowspan="1" colspan="1">1954-1998, 300</td>
<td align="left" valign="top" rowspan="1" colspan="1">64</td>
<td align="left" valign="top" rowspan="1" colspan="1">I:64%, II:21%, III:10</td>
<td align="left" valign="top" rowspan="1" colspan="1">NR</td>
<td align="left" valign="top" rowspan="1" colspan="1">109</td>
<td align="left" valign="top" rowspan="1" colspan="1">39%</td>
<td align="left" valign="top" rowspan="1" colspan="1">Sx: 38%; Sx + RT: 53%; RT alone: 9%; Additional ChT: 16%</td>
<td align="left" valign="top" rowspan="1" colspan="1">5y:31%</td>
<td align="left" valign="top" rowspan="1" colspan="1">NR</td>
<td align="left" valign="top" rowspan="1" colspan="1">5y: 33%</td>
<td align="left" valign="top" rowspan="1" colspan="1">5y: 62% pelvis control</td>
<td align="left" valign="top" rowspan="1" colspan="1">Adjuvant RT</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1">Denschlag 2007<sup><xref rid="ref29" ref-type="bibr">29</xref>
</sup>
</td>
<td align="left" valign="top" rowspan="1" colspan="1">1989-2004, 36/94</td>
<td align="left" valign="top" rowspan="1" colspan="1">60</td>
<td align="left" valign="top" rowspan="1" colspan="1">I:42%, II:14%, III: 17%, IV: 6%</td>
<td align="left" valign="top" rowspan="1" colspan="1">NR</td>
<td align="left" valign="top" rowspan="1" colspan="1">48</td>
<td align="left" valign="top" rowspan="1" colspan="1">74% whole study population</td>
<td align="left" valign="top" rowspan="1" colspan="1">Sx + RT: 15pts; Sx + RT + ChT: 13 pts</td>
<td align="left" valign="top" rowspan="1" colspan="1">5y: 47%, whole study population</td>
<td align="left" valign="top" rowspan="1" colspan="1">5y: 41%, whole study population</td>
<td align="left" valign="top" rowspan="1" colspan="1">NR</td>
<td align="left" valign="top" rowspan="1" colspan="1">NR</td>
<td align="left" valign="top" rowspan="1" colspan="1">OS: Age, P=0.0015, adjuvant RT tor UCS, P=0.003</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1">Clayton Smith 2008<sup><xref rid="ref26" ref-type="bibr">26</xref>
</sup>
</td>
<td align="left" valign="top" rowspan="1" colspan="1">1973-2003, 2461</td>
<td align="left" valign="top" rowspan="1" colspan="1">70</td>
<td align="left" valign="top" rowspan="1" colspan="1">I-IV</td>
<td align="left" valign="top" rowspan="1" colspan="1">NR</td>
<td align="left" valign="top" rowspan="1" colspan="1">47</td>
<td align="left" valign="top" rowspan="1" colspan="1">NR</td>
<td align="left" valign="top" rowspan="1" colspan="1">RT: 36%; Sx: 64%</td>
<td align="left" valign="top" rowspan="1" colspan="1">5y: RT: 42.2%, Sx: 33.1%</td>
<td align="left" valign="top" rowspan="1" colspan="1">5y: (Uterine specific survival), RT: 56.7%, Sx: 50.7%</td>
<td align="left" valign="top" rowspan="1" colspan="1">NR</td>
<td align="left" valign="top" rowspan="1" colspan="1">NR</td>
<td align="left" valign="top" rowspan="1" colspan="1">Adjuvant RT</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1">Ghaemmaghami 2008<sup><xref rid="ref16" ref-type="bibr">16</xref>
</sup>
</td>
<td align="left" valign="top" rowspan="1" colspan="1">1999-2004, 17/57</td>
<td align="left" valign="top" rowspan="1" colspan="1">50</td>
<td align="left" valign="top" rowspan="1" colspan="1">NR tor subgroup UCS, whole study population, I:52.5%, II:16%, III: 21%, IV: 10.5%</td>
<td align="left" valign="top" rowspan="1" colspan="1">NR</td>
<td align="left" valign="top" rowspan="1" colspan="1">19</td>
<td align="left" valign="top" rowspan="1" colspan="1">UCS: 64%</td>
<td align="left" valign="top" rowspan="1" colspan="1">UCS: Sx: 17 pts; Sx+RT: 1 pt; (Sx + RT: whole study population: 14 pts)</td>
<td align="left" valign="top" rowspan="1" colspan="1">5y:52%, whole study population: UCS, 41%</td>
<td align="left" valign="top" rowspan="1" colspan="1">NR</td>
<td align="left" valign="top" rowspan="1" colspan="1">NR</td>
<td align="left" valign="top" rowspan="1" colspan="1">5y: 75% whole study population</td>
<td align="left" valign="top" rowspan="1" colspan="1">Stage, histology, grading, Local control: adjvant RT >50 Gy</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1">Sorbe 2008<sup><xref rid="ref20" ref-type="bibr">20</xref>
</sup>
</td>
<td align="left" valign="top" rowspan="1" colspan="1">1975-2003, 60/155</td>
<td align="left" valign="top" rowspan="1" colspan="1">64.5 (mean) whole study population</td>
<td align="left" valign="top" rowspan="1" colspan="1">NR tor subgroup UCS, whole study population, I:61%, II:6%, III:17%, IV: 15%</td>
<td align="left" valign="top" rowspan="1" colspan="1">NR</td>
<td align="left" valign="top" rowspan="1" colspan="1">160 whole study population</td>
<td align="left" valign="top" rowspan="1" colspan="1">7.1.% whole study population</td>
<td align="left" valign="top" rowspan="1" colspan="1">Stage I, II:40 pts; Sx: 4 pts; Sx + RT: 36 pts</td>
<td align="left" valign="top" rowspan="1" colspan="1">5y: NR for UCS; whole study population 42%</td>
<td align="left" valign="top" rowspan="1" colspan="1">NR</td>
<td align="left" valign="top" rowspan="1" colspan="1">NR</td>
<td align="left" valign="top" rowspan="1" colspan="1">Crude rate Sx: 3 pts, Sx + RT: 28 pts</td>
<td align="left" valign="top" rowspan="1" colspan="1">Tumor stage, histology, number of mitoses</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1">Nemani 2008<sup><xref rid="ref21" ref-type="bibr">21</xref>
</sup>
</td>
<td align="left" valign="top" rowspan="1" colspan="1">1988-2003, 1855</td>
<td align="left" valign="top" rowspan="1" colspan="1">NR</td>
<td align="left" valign="top" rowspan="1" colspan="1">I:65%, II:14%, III: 21%</td>
<td align="left" valign="top" rowspan="1" colspan="1">NR</td>
<td align="left" valign="top" rowspan="1" colspan="1">NR</td>
<td align="left" valign="top" rowspan="1" colspan="1">57%</td>
<td align="left" valign="top" rowspan="1" colspan="1">Sx: 939; Sx + RT: 653 pts</td>
<td align="left" valign="top" rowspan="1" colspan="1">5y: no lymph node dissection; Sx: 33%, Sx + RT: 36%</td>
<td align="left" valign="top" rowspan="1" colspan="1">5y: improved with RT</td>
<td align="left" valign="top" rowspan="1" colspan="1">NR</td>
<td align="left" valign="top" rowspan="1" colspan="1">NR</td>
<td align="left" valign="top" rowspan="1" colspan="1">Lymph node dissection</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1">Sampath 2010<sup><xref rid="ref10" ref-type="bibr">10</xref>
</sup>
</td>
<td align="left" valign="top" rowspan="1" colspan="1">1980-2005, 1877/3650</td>
<td align="left" valign="top" rowspan="1" colspan="1">64</td>
<td align="left" valign="top" rowspan="1" colspan="1">NR tor subgroup UCS, I: 30%, II:7%, III: 12%, IV: 13.5%, unknown: 37.5%</td>
<td align="left" valign="top" rowspan="1" colspan="1">NR</td>
<td align="left" valign="top" rowspan="1" colspan="1">59.3</td>
<td align="left" valign="top" rowspan="1" colspan="1">Node positive: 7.9%; node negative: 51.6%, unknown; 40.5%</td>
<td align="left" valign="top" rowspan="1" colspan="1">RT: 490 pts; No RT: 638 pts</td>
<td align="left" valign="top" rowspan="1" colspan="1">5y: whole study population: 37%</td>
<td align="left" valign="top" rowspan="1" colspan="1">NR</td>
<td align="left" valign="top" rowspan="1" colspan="1">NR</td>
<td align="left" valign="top" rowspan="1" colspan="1">5y: RT:90%, No RT: 80%, P<0.001</td>
<td align="left" valign="top" rowspan="1" colspan="1">Adjuvant RT</td>
</tr>
<tr><td align="left" valign="top" rowspan="1" colspan="1">Zwahlen 2013</td>
<td align="left" valign="top" rowspan="1" colspan="1">1987-2007, 124</td>
<td align="left" valign="top" rowspan="1" colspan="1">66.5</td>
<td align="left" valign="top" rowspan="1" colspan="1">I:52%, II:14%, III: 28%, IV: 3%</td>
<td align="left" valign="top" rowspan="1" colspan="1">9.7%</td>
<td align="left" valign="top" rowspan="1" colspan="1">40</td>
<td align="left" valign="top" rowspan="1" colspan="1">61%</td>
<td align="left" valign="top" rowspan="1" colspan="1">RT: 88%, ChT: 20%</td>
<td align="left" valign="top" rowspan="1" colspan="1">5y: 51.7%</td>
<td align="left" valign="top" rowspan="1" colspan="1">5y: 53.7.6%</td>
<td align="left" valign="top" rowspan="1" colspan="1">5y: 58.6%</td>
<td align="left" valign="top" rowspan="1" colspan="1">5y: 48%</td>
<td align="left" valign="top" rowspan="1" colspan="1">adjuvant RT, FIGO stage I-II vs. III-IV, age (60 vs. > 60 years). LAD, higher BT dose</td>
</tr>
</tbody>
</table>
<table-wrap-foot><fn><p>FIGO, International Federation of Gyneecology and Obstetrics; FU, follow up; LAD, lymphadenectomy; OS, overall survival; DFS, disease free survival; CSS, cause-specific survival; LRC, locoregional control; NR, not reported; ChT, Chemotherapy; HT, hormonal therapy; RT, radiotherapy; EBRT, External Beam RT; BT, Brachytherapy; Tx, Treatment; MT, metastases; Sx, surgery; BSO, bilateral salpingooophorectomy; pts, patients, n.s., not statistically significant; Numbers underlined represent UCS only; Other abbreviations as in <xref ref-type="table" rid="table001">Tables 1</xref>
and <xref ref-type="table" rid="table002">2</xref>
.</p>
</fn>
</table-wrap-foot>
</table-wrap>
</floats-group>
</pmc>
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