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THE DIAGNOSTIC PROBLEM OF ENDOMETRIAL STROMAL SARCOMA: REPORT ON SIX CASES

Objectives: To evaluate survival of patients with carcinosarcoma treated in our institution during the period 1976—98. Methods : A total of 104 patients were treated for uterine and 17 for ovarian CS. Surgery consisted of total abdominal hysterectomy with bilateral adnexextirpation and surgical debulking in advanced cases. Postoperatively, patients treated in the eighties had either radiation to a pelvic field or chemotherapy with doxorubicin single, or in combination with dactinomycin, oncovin and cyclophosphamid. In the nineties, patients were mainly treated with combination chemotherapy with cisplatin, ifosfamid and etoposide (VIP). Results: : The distribution to FIGO stage I, II, III and IV was: 52, 12, 17 and 23 patients, respectively. The calculated 5 year survival rates were: 54%, 42%, 28% and 8% for FIGO stage I, II, III and IV, respectively. In stage I, the calculated 5 year survival was: 88%, 55%, 36% and 29% for patients given adjuvant treatment with VIP, radiation to a pelvic field, doxorubicin single or no treatment, respectively. For patients with advanced stages, the median survival was 9 months without clear differences related to postsurgical treatment. Most patients with ovarian CS had advanced disease and only 4 patients were rendered macroscopically tumorfree at surgery. The median survival was 8 months for the total group. For patients given postoperative chemotherapy, the median survival was 21,5 months. Conclusions: : Most patients with CS had disease in advanced stage at diagnosis conferring a poor prognosis. For patients with uterine CS in stage I, the survival increased considerably when chemotherapy with the VIP regime was given.