1. Clinical features and outcome in ovarian sarcomas: Analysis of a single-institution experience A López Pousa, X Gonzàlez Farré, MJ. Quintana, S Bagué, O Gallego, A Tibau, J Pérez, N Sala, JM. Mazarico, V Artigas, A Barnadas

2. Background Gynaecologic sarcomas are very uncommon tumours. –Uterine sarcoma  3 – 6% of uterine malignancies. –Ovarian sarcoma  Less than 1% of ovarian tumours. Most of them are carcinosarcoma. Less than 400 cases reported in the literature. Ovarian carcinosarcoma usually present with advanced disease. Survival seems to be worse than epithelial ovarian cancer. Monoclonal theory: –The epithelial component begins tumorigenesis. –Sarcomatous component is a metaplastic event during the evolution. Objective: To analyse their clinical features and outcome.

3. Methods We analysed retrospectively patients with ginaecologycal sarcomas treated at our institution between 1978 and 2007. Minimun follow-up 1 y. Retrospective data collection using medical charts. All the cases were reviewed by a single expert pathologist. 123 GS 100 GS 13 ovarian sarcoma 1 ovarian leyomiosarcoma 12 ovarian carcinosarcoma 87 uterine sarcoma 23 excluded for: Follow up < 1 y. Missing data

4. Clinical features Median age: 63 years (45 – 77) Hormonal substitutive therapy in only 1 patient. (4 not known) First symptom FIGO staging

5. Pathology Diagnosis: Hysterectomy or laparoscopic exploration. Histologic gradeTumor size

6. Treatment All patients underwent total abdominal hysterectomy and bilateral salpingoophorectomy. Type of resection: –4 patients optimal cytoreduction –8 patients suboptimal cytoreduction (including 1 stage IV tumor) Adjuvant chemotherapy: –CDDP + Doxorubicine = 5 –CYVADIC = 4 –CBDCA – paclitaxel = 1 –Ifosfamide = 1 –Doxorubicine + Ifosfamide = 1 Platinum CT vs not: 6/6 Doxorubicine CT vs not: 10 vs 2

7. Results Median Follow-up:46 months Nr of cycles: 6 (4-16) Relapsed patients: 7/11 ( 63 %) Type Of Relapse: –Local: 6/7 –Distant + local 1/7 Time To relapse:48 (6-129) months Treatment of relapsed disease –Radical surgery + chemotherapy: 3/7 cases –Palliative chemoterapy: 4/7

8. Results: Overall survival

9. Results: Overall survival & stage

10. Results: Overall survival & Surgery

11. Results: Overall survival & CHT

12. Results: OS & relapse treatment

13. Conclusions Due to the rarity of ovarian carcinosarcomas there are not prospective studies reported in the medical literature. The majority of retrospective analysis show that optimal surgery improves survival. The optimal chemotherapeutic regimen to treat this aggressive disease is yet to be determined. Most of the reviews recommend platinum based CTs.

14. Conclusions When feasible, aggressive approach for peritoneal recurrent disease should be considered. Prognosis of this infrequent disease seems to be worse than ovarian epithelial carcinoma, but in our series, probably due to the small number of cases, we have not found this result.