Uterine Carcinosarcoma after Pelvic Radiotherapy

Radiation is a treatment of many gynecologic malignancies, especially locally-advanced cervical cancer. Development of second malignancies is a rare complication of radiotherapy. Our patient had uterine carsinosarcoma20 years after radiotherapy for cervical cancer. Two theories of radiationinduced malignancies were described: direct damage of double strand DNA and the abscopal or indirect damage. No difference in treatment of second cancer (uterine carsinosarcoma) from primary cancer is recommended. However, poor pelvic blood supply form previous radiation may affect tissue healing and the delivery of adjuvant chemotherapy. Our patient had poor prognosis with advanced stage at the time of presentation, rapidly progressed after completion of treatment, and died only 11 months after diagnosis. Uterine carcinosarcoma or malignant mixed mullerian tumor is a biphasic tumor composed of highgrade carcinoma and sarcoma elements [1]. It is a rare gynecological neoplasm (< 5% of all uterine malignancies) [1]. The median ages of diagnosis reported among published series ranged from 62-67 years [2]. The prognosis of uterine carcinosarcoma is poor with a 5-year overall survival of only 30% [3]. Several risk factors for carcinosarcoma were tamoxifen therapy, long-term unopposed estrogen usage, previous radiotherapy, and etc. History of previous pelvic radiotherapy was discovered as high as 37% of carcinosarcoma patients [3]. We reported a patient with advanced-stage uterine carcinosarcoma after a long interval after pelvic radiation for cervical cancer. The clinical, radiographic, pathologic features, management and outcome of the patient were presented. Chaowawanit W and Tangjitgamo S* Department of Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Thailand Tangjitgamo S, et al. Clinics in Oncology Endometrial Cancer Remedy Publications LLC., | http://clinicsinoncology.com/ 2016 | Volume 1 | Article 1049 2 Postoperative course was uneventful. Paclitaxel 175 mg/ m2 and carboplatin AUC 6 were given for 6 cycles before pelvic radiation as adjuvant therapy. There were no evidences of diseases by physical examination and transvaginal pelvic ultrasonography after completion of treatment. CA-125 was 33.5 U/ml. Three months later, she developed abdominal discomfort. Physical examination showed marked ascites and a 4-cm supravaginal stump pelvic mass. Her CA-125 elevated to 173.4 U/ml. Computerize tomography (CT) showed pelvic mass, sized 3.8 x 4 cm locating in mid lower pelvis with bladder wall thickening, and circumferential rectal and long segmental bowel wall thickening. Large amount of ascites and carcinomatosis peritoneiwere also noted. Taken into consideration her cancer prognosis and poor performance status (ECOG 3), only palliative progestin with intermittent abdominal paracentesis to relieve symptoms were given. She consequently developed obstructive nephropathy, uremia and died11 months after surgery.