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Review
. 2020 Aug;158(2):460-466.
doi: 10.1016/j.ygyno.2020.04.683. Epub 2020 May 29.

Executive summary of the American Radium Society® Appropriate Use Criteria for management of uterine carcinosarcoma

Mohamed A Elshaikh  1 , Ankit Modh  2 , Anuja Jhingran  3 , Matthew C Biagioli  4 , Robert L Coleman  3 , David K Gaffney  5 , Matthew M Harkenrider  6 , Karen Heskett  7 , Shruti Jolly  8 , Elizabeth Kidd  9 , Larissa J Lee  10 , Linna Li  11 , Lorraine Portelance  12 , Tracy Sherertz  13 , Aradhana M Venkatessan  3 , Andrew O Wahl  14 , Catheryn M Yashar  7 , William Small Jr  6
Affiliations
Review

Executive summary of the American Radium Society® Appropriate Use Criteria for management of uterine carcinosarcoma

Mohamed A Elshaikh et al. Gynecol Oncol. 2020 Aug.

Abstract

Objective: Uterine carcinosarcomas (UCS) represent a rare but aggressive subset of endometrial cancers, comprising <5% of uterine malignancies. To date, limited prospective trials exist from which evidence-based management of this rare malignancy can be developed.

Methods: The American Radium Society Appropriate Use Criteria presented in this manuscript are evidence-based guidelines developed by a multidisciplinary expert panel for management of women with UCS. An extensive analysis of current medical literature from peer-reviewed journals was performed. A well-established methodology (modified Delphi) was used to rate the appropriate use of imaging and treatment procedures for the management of UCS. These guidelines are intended for the use of all practitioners who desire information about the management of UCS.

Results: The majority of patients with UCS will present with advanced extra uterine disease, with 10% presenting with metastatic disease. They have worse survival outcomes when compared to uterine high-grade endometrioid adenocarcinomas. The primary treatment for non-metastatic UCS is complete surgical staging with total hysterectomy, salpingo-oophorectomy and lymph node staging. Patients with UCS appear to benefit from adjuvant multimodality therapy to reduce the chance of tumor recurrence with the potential to improve overall survival.

Conclusion: Women diagnosed with uterine UCS should undergo complete surgical staging. Adjuvant multimodality therapies should be considered in the treatment of both early- and advanced stage patients. Long-term surveillance is indicated as many of these women may recur. Prospective clinical studies of women with UCS are necessary for optimal management.

Keywords: Carcinosarcoma; Chemotherapy; Hysterectomy; Radiotherapy; Uterine neoplasms.

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Conflict of interest statement

Declaration of competing interest All panelists were required to declare all conflicts of interest for the previous 36 months prior to initiating work on this document. These complete disclosure forms are retained by the American Radium Society in perpetuity. The ARS Appropriate Use Criteria Steering Committee reviewed these disclosures with the chair and co-chair of this document and approved participation of the panelists prior to starting development of this work. Disclosures potentially relevant to the content of this guideline are provided. Dr. Biagioli receives consulting fees/honoraria from Elekta, Inc. Dr. Coleman receives grants for clinical trials from NCI-CTEP, NCI-SPORE, CPRIT, V-foundation, Gateway Foundation, Roche-Genentech, Merck, Abbvie, Clovis Oncology, Janssen, Astra-Zeneca. He also serves as an advisor to AstraZeneca, Clovis, Tesaro, GenMab, Gamamab, Janssen, Roche-Genentech, Bayer, Merck, and Abbvie-Stemcentrx. Dr. Harkenrider received personal fees for serving on the Varian Brachytherapy Advisory Board and AstraZeneca Advisory Board. Dr. Jolly receives consulting fees from AstraZeneca and Varian Medical Systems. Dr. Lee reports grants and non-financial support from Astra Zeneca, grants from Koch Institute at MIT and DF/HCC, and grants from Dana-Farber Cancer Institute. Dr. Portelance receives consulting fees, honoraria, and travel expenses from Biocompatibles, Sirtex Medical, ViewRay Technologies, and Elekta. Dr. Small receives travel support/honoraria for his role on the Merck and Varian Advisory Board and sponsored talks for Zeiss. Dr. Venkatesan receives grants from the Radiological Society of North America (RSNA), the University of Texas MD Anderson Cancer Center (UTMDACC) and the NIH/NCI under award number P30CA016672 and the UTMDACC Radiation Oncology and Cancer Imaging Program.

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