Combination chemotherapy with doxorubicin and DTIC, or these two drugs plus vincristine and cyclophosphamide, was yielded somewhat higher response rates (478–480). Similarly, ifosfamide was combined with mesnauroprotection, doxorubicin, and DTIC to treat metastatic pure sarcomas (481). Gemcitabine combined with docetaxel for treatment of metastatic leiomyosarcoma yielded an overall response rate of 53%, including patients previously treated with doxorubicin (482). Median time to progression was 5.6 months. Several retrospective investigations concluded that neither chemotherapy nor radiation impacts survival for patients with ESS or leiomyosarcoma (428,483,484).
Combined ifosfamide and cisplatin chemotherapy resulted in a higher response rate (54% versus 36%) and a longer progression-free survival than ifosfamide chemotherapy alone for treatment of advanced carcinosarcoma (485). Overall survival was unchanged (8 versus 9 months), and the combined regimen was significantly more toxic. A 3-day regimen of ifosfamide with or without paclitaxel in patients with advanced and recurrent carcinosarcoma demonstrated improved response rates (29% versus 45%) and median overall survival (8 versus 13 months) in the combination chemotherapy arm (486). This regimen appears to be the most efficacious for patients with advanced or recurrent carcinosarcoma. A combination of paclitaxel and carboplatin for treatment of advanced uterine carcinosarcoma resulted in a complete response rate of 80% and a median progression-free interval of 18 months (487). The GOG completed a phase II evaluation of paclitaxel and carboplatin with the results awaiting maturation. A randomized phase III evaluation of paclitaxel plus carboplatin versus ifosfamide plus paclitaxel in chemotherapy naive patients with carcinosarcoma is accruing.
Adjuvant Treatment Because of the relatively low survival rate in localized uterine sarcomas and the high incidence of failure resulting from subsequent distant metastasis, adjuvant treatment programs employing chemotherapy were tested (487–490). Most reports were unable to show a clear improvement in survival by the addition of postoperative adjuvant chemotherapy in early uterine sarcoma. The GOG conducted a trial of postoperative adjuvant doxorubicin in stage I and II uterine sarcoma patients. Of the 75 patients randomized to receive doxorubicin, 41% developed a recurrence, compared with 53% of 81 patients receiving no adjuvant chemotherapy, but these differences were not significant (487). Other smaller, nonrandomized adjuvant chemotherapy studies employing cyclophosphamide, cisplatin plus doxorubicin, and ifosfamide plus cisplatin reported recurrence rates of 33%, 24%, and 31%, respectively (488–490).
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