J Gynecol Oncol.  2010 Dec;21(4):209-218. 10.3802/jgo.2010.21.4.209.

Major clinical research advances in gynecologic cancer in 2010

• Suh DH
• Kim JW
• Kim K
• Kang SB

• KMID: 2173543
• DOI: http://doi.org/10.3802/jgo.2010.21.4.209

Abstract

This review summarizes 11 major clinical research advances in gynecologic oncology in 2010. For ovarian cancer, bevacizumab as a leading molecular targeted agent, pegylated liposomal doxorubicin in recurrent disease, the role of neoadjuvant chemotherapy in an advanced setting, an effective screening method, and ARID1A mutations as a clue to the origin of clear cell carcinoma are mentioned. For cervical cancer, confirmation of the efficacy and the introduction of a self collection method of the human papillomavirus (HPV) test, and the association between the HPV vaccine and miscarriage are examined. For endometrial cancer, the superiority of laparoscopy in staging operation, the role of vaginal brachytherapy in an adjuvant setting, and the effect of para-aortic lymph node dissection are reviewed. In addition, the trend of geriatric oncology and chemotherapy in carcinosarcomas is also assessed.

Keyword

Bevacizumab; Ovarian cancer screening; Geriatric oncology

MeSH Terms

Abortion, Spontaneous
Antibodies, Monoclonal, Humanized
Bevacizumab
Brachytherapy
Carcinosarcoma
Doxorubicin
Endometrial Neoplasms
Female
Humans
Laparoscopy
Lymph Node Excision
Mass Screening
Ovarian Neoplasms
Polyethylene Glycols
Pregnancy
Uterine Cervical Neoplasms
Antibodies, Monoclonal, Humanized
Doxorubicin
Polyethylene Glycols

Reference

1. Kim K, Ryu SY. Major clinical research advances in gynecologic cancer 2009. J Gynecol Oncol. 2009. 20:203–209.

2. Burger RA, Sill MW, Monk BJ, Greer BE, Sorosky JI. Phase II trial of bevacizumab in persistent or recurrent epithelial ovarian cancer or primary peritoneal cancer: a Gynecologic Oncology Group Study. J Clin Oncol. 2007. 25:5165–5171.

3. Cannistra SA, Matulonis UA, Penson RT, Hambleton J, Dupont J, Mackey H, et al. Phase II study of bevacizumab in patients with platinum-resistant ovarian cancer or peritoneal serous cancer. J Clin Oncol. 2007. 25:5180–5186.

4. Garcia AA, Hirte H, Fleming G, Yang D, Tsao-Wei DD, Roman L, et al. Phase II clinical trial of bevacizumab and low-dose metronomic oral cyclophosphamide in recurrent ovarian cancer: a trial of the California, Chicago, and Princess Margaret Hospital phase II consortia. J Clin Oncol. 2008. 26:76–82.

5. Ledermann JA, Raja FA. Targeted trials in ovarian cancer. Gynecol Oncol. 2010. 119:151–156.

6. Burger RA, Brady MF, Bookman MA, Walker JL, Homesley HD, Fowler J, et al. Phase III trial of bevacizumab (BEV) in the primary treatment of advanced epithelial ovarian cancer (EOC), primary peritoneal cancer (PPC), or fallopian tube cancer (FTC): a Gynecologic Oncology Group study. In : 2010 ASCO Annual Meeting; Abstract LBA1.

7. Perren T, Swart AM, Pfisterer J, Ledermann J, Lortholary A, Kristensen G, et al. ICON7: a phase III randomised gynaecologic cancer intergroup trial of concurrent bevacizumab and chemotherapy followed by maintenance bevacizumab, versus chemotherapy alone in women with newly diagnosed epithelial ovarian (EOC), primary peritoneal (PPC) or fallopian tube cancer (FTC). In : ESMO 2010; Abstract LBA4.

8. Han ES, Monk BJ. What is the risk of bowel perforation associated with bevacizumab therapy in ovarian cancer? Gynecol Oncol. 2007. 105:3–6.

9. Avastin full prescribing information: inications [Internet]. 2009. cited 2010 Nov 14. South San Francisco: Genentech, Inc.;Available from: http://www.gene.com/gene/products/information/pdf/avastin-prescribing.pdf.

10. Berek JS, Bertelsen K, du Bois A, Brady MF, Carmichael J, Eisenhauer EA, et al. Advanced epithelial ovarian cancer: 1998 consensus statements. Ann Oncol. 1999. 10:Suppl 1. 87–92.

11. Orlando M, Costanzo MV, Chacon RD, Tajer CD. Randomized trials of combination chemotherapy (combo) versus monotherapy (mono) in relapsed ovarian carcinoma (ROC): a meta-analysis of published data. 2007. In : ASCO Annual Meeting; Abstract 5524.

12. Parmar MK, Ledermann JA, Colombo N, du Bois A, Delaloye JF, Kristensen GB, et al. Paclitaxel plus platinum-based chemotherapy versus conventional platinum-based chemotherapy in women with relapsed ovarian cancer: the ICON4/AGO-OVAR-2.2 trial. Lancet. 2003. 361:2099–2106.

13. Pfisterer J, Ledermann JA. Management of platinum-sensitive recurrent ovarian cancer. Semin Oncol. 2006. 33:2 Suppl 6. S12–S16.

14. Pfisterer J, Plante M, Vergote I, du Bois A, Hirte H, Lacave AJ, et al. Gemcitabine plus carboplatin compared with carboplatin in patients with platinum-sensitive recurrent ovarian cancer: an intergroup trial of the AGO-OVAR, the NCIC CTG, and the EORTC GCG. J Clin Oncol. 2006. 24:4699–4707.

15. Murgia V, Sorio R, Griso C, Caffo O, Arcuri C, Ferro A, et al. Multicenter phase 2 study of combined gemcitabine and epirubicin as second-line treatment for patients with advanced ovarian cancer. Int J Gynecol Cancer. 2010. 20:953–957.

16. Kim HS, Park NH, Kang S, Seo SS, Chung HH, Kim JW, et al. Comparison of the efficacy between topotecan- and belotecan-, a new camptothecin analog, based chemotherapies for recurrent epithelial ovarian cancer: a single institutional experience. J Obstet Gynaecol Res. 2010. 36:86–93.

17. Nam EJ, Kim JW, Kim JH, Kim S, Kim SW, Jang SY, et al. Efficacy and toxicity of belotecan with and without cisplatin in patients with recurrent ovarian cancer. Am J Clin Oncol. 2010. 33:233–237.

18. Kim YM, Lee SW, Kim DY, Kim JH, Nam JH, Kim YT. The efficacy and toxicity of belotecan (CKD-602), a camptothericin analogue topoisomerase I inhibitor, in patients with recurrent or refractory epithelial ovarian cancer. J Chemother. 2010. 22:197–200.

19. Cannistra SA. Evaluating new regimens in recurrent ovarian cancer: how much evidence is good enough? J Clin Oncol. 2010. 28:3101–3103.

20. Monk BJ, Herzog TJ, Kaye SB, Krasner CN, Vermorken JB, Muggia FM, et al. Trabectedin plus pegylated liposomal Doxorubicin in recurrent ovarian cancer. J Clin Oncol. 2010. 28:3107–3114.

21. Gordon AN, Fleagle JT, Guthrie D, Parkin DE, Gore ME, Lacave AJ. Recurrent epithelial ovarian carcinoma: a randomized phase III study of pegylated liposomal doxorubicin versus topotecan. J Clin Oncol. 2001. 19:3312–3322.

22. Gordon AN, Tonda M, Sun S, Rackoff W. Doxil Study 30-49 Investigators. Long-term survival advantage for women treated with pegylated liposomal doxorubicin compared with topotecan in a phase 3 randomized study of recurrent and refractory epithelial ovarian cancer. Gynecol Oncol. 2004. 95:1–8.

23. Ferrandina G, Ludovisi M, Lorusso D, Pignata S, Breda E, Savarese A, et al. Phase III trial of gemcitabine compared with pegylated liposomal doxorubicin in progressive or recurrent ovarian cancer. J Clin Oncol. 2008. 26:890–896.

24. Pujade-Lauraine E, Wagner U, Aavall-Lundqvist E, Gebski V, Heywood M, Vasey PA, et al. Pegylated liposomal Doxorubicin and Carboplatin compared with Paclitaxel and Carboplatin for patients with platinum-sensitive ovarian cancer in late relapse. J Clin Oncol. 2010. 28:3323–3329.

25. Holloway RW, Grendys EC, Lefebvre P, Vekeman F, McMeekin S. Tolerability, efficacy, and safety of pegylated liposomal Doxorubicin in combination with Carboplatin versus gemcitabine-Carboplatin for the treatment of platinum-sensitive recurrent ovarian cancer: a systematic review. Oncologist. 2010. 15:1073–1082.

26. Poveda A, Vergote I, Tjulandin S, Kong B, Roy M, Chan S, et al. Trabectedin plus pegylated liposomal doxorubicin in relapsed ovarian cancer outcomes in the partially platinum-sensitive platinum-free interval 6-12 months subpopulation of OVA-301 phase III randomized trial. Ann Oncol. 2010. 07. 19. [Epub]. DOI: 10.1093/annonc/mdq352.

27. Kaye SB, Colombo N, Monk BJ, Tjulandin S, Kong B, Roy M, et al. Trabectedin plus pegylated liposomal doxorubicin in relapsed ovarian cancer delays third-line chemotherapy and prolongs the platinum-free interval. Ann Oncol. 2010. 07. 19. [Epub]. DOI: 10.1093/annonc/mdq353.

28. Vergote I, Trope CG, Amant F, Kristensen GB, Ehlen T, Johnson N, et al. Neoadjuvant chemotherapy or primary surgery in stage IIIC or IV ovarian cancer. N Engl J Med. 2010. 363:943–953.

29. Vergote I, Amant F, Leunen K. Neoadjuvant chemotherapy in advanced ovarian cancer: what kind of evidence is needed to convince US gynaecological oncologists? Gynecol Oncol. 2010. 119:1–2.

30. Chi DS, Eisenhauer EL, Lang J, Huh J, Haddad L, Abu-Rustum NR, et al. What is the optimal goal of primary cytoreductive surgery for bulky stage IIIC epithelial ovarian carcinoma (EOC)? Gynecol Oncol. 2006. 103:559–564.

31. Kim K, Choi SC, Ryu SY, Kim JW, Kang SB. Major clinical research advances in gynecologic cancer 2008. J Gynecol Oncol. 2008. 19:209–217.

32. Dewdney SB, Rimel BJ, Reinhart AJ, Kizer NT, Brooks RA, Massad LS, et al. The role of neoadjuvant chemotherapy in the management of patients with advanced stage ovarian cancer: survey results from members of the Society of Gynecologic Oncologists. Gynecol Oncol. 2010. 119:18–21.

33. Heintz AP, Odicino F, Maisonneuve P, Quinn MA, Benedet JL, Creasman WT, et al. Carcinoma of the ovary: FIGO 6th annual report on the results of treatment in gynecological cancer. Int J Gynaecol Obstet. 2006. 95:Suppl 1. S161–S192.

34. Clarke-Pearson DL. Clinical practice: screening for ovarian cancer. N Engl J Med. 2009. 361:170–177.

35. Clinical practice guidelines in oncology. Genetic/familial high-risk assessment: breast and ovarian V.I.2010 [Internet]. cited 2010 Nov 14. Fort Washington: National Comprehensive Cancer Network;Available from: http://www.nccn.org/professionals/physician_gls/PDF/genetics_screening.pdf.

36. U.S. Preventive Services Task Force. Screening for ovarian cancer: recommendation statement. U.S. Preventive Services Task Force. Am Fam Physician. 2005. 71:759–762.

37. American College of Obstetricians and Gynecologists. Committee on Gynecologic Practice. ACOG committee opinion: Von Willebrand's disease in gynecologic practice. Int J Gynaecol Obstet. 2002. 76:336–337.

38. Partridge E, Kreimer AR, Greenlee RT, Williams C, Xu JL, Church TR, et al. Results from four rounds of ovarian cancer screening in a randomized trial. Obstet Gynecol. 2009. 113:775–782.

39. Menon U, Gentry-Maharaj A, Hallett R, Ryan A, Burnell M, Sharma A, et al. Sensitivity and specificity of multimodal and ultrasound screening for ovarian cancer, and stage distribution of detected cancers: results of the prevalence screen of the UK Collaborative Trial of Ovarian Cancer Screening (UKCTOCS). Lancet Oncol. 2009. 10:327–340.

40. Lu KH, Skates S, Bevers TB, Newland W, Moore RG, Leeds L, et al. A prospective U.S. ovarian cancer screening study using the risk of ovarian cancer algorithm (ROCA). In : 2010 ASCO Annual Meeting; Abstract 5003.

41. Itamochi H, Kigawa J, Terakawa N. Mechanisms of chemoresistance and poor prognosis in ovarian clear cell carcinoma. Cancer Sci. 2008. 99:653–658.

42. Jones S, Wang TL, Shih Ie M, Mao TL, Nakayama K, Roden R, et al. Frequent mutations of chromatin remodeling gene ARID1A in ovarian clear cell carcinoma. Science. 2010. 330:228–231.

43. Veras E, Mao TL, Ayhan A, Ueda S, Lai H, Hayran M, et al. Cystic and adenofibromatous clear cell carcinomas of the ovary. Distinctive tumors that differ in their pathogenesis and behavior: a clinicopathologic analysis of 122 cases. Am J Surg Pathol. 2009. 33:844–853.

44. Vigano P, Somigliana E, Chiodo I, Abbiati A, Vercellini P. Molecular mechanisms and biological plausibility underlying the malignant transformation of endometriosis: a critical analysis. Hum Reprod Update. 2006. 12:77–89.

45. Ness RB. Endometriosis and ovarian cancer: thoughts on shared pathophysiology. Am J Obstet Gynecol. 2003. 189:280–294.

46. Wiegand KC, Shah SP, Al-Agha OM, Zhao Y, Tse K, Zeng T, et al. ARID1A mutations in endometriosis-associated ovarian carcinomas. N Engl J Med. 2010. 363:1532–1543.

47. Reisman D, Glaros S, Thompson EA. The SWI/SNF complex and cancer. Oncogene. 2009. 28:1653–1668.

48. Naucler P, Ryd W, Tornberg S, Strand A, Wadell G, Elfgren K, et al. Human papillomavirus and Papanicolaou tests to screen for cervical cancer. N Engl J Med. 2007. 357:1589–1597.

49. Bulkmans NW, Berkhof J, Rozendaal L, van Kemenade FJ, Boeke AJ, Bulk S, et al. Human papillomavirus DNA testing for the detection of cervical intraepithelial neoplasia grade 3 and cancer: 5-year follow-up of a randomised controlled implementation trial. Lancet. 2007. 370:1764–1772.

50. Kitchener HC, Almonte M, Thomson C, Wheeler P, Sargent A, Stoykova B, et al. HPV testing in combination with liquid-based cytology in primary cervical screening (ARTISTIC): a randomised controlled trial. Lancet Oncol. 2009. 10:672–682.

51. Clinical practice guidelines in oncology. Cervical cancer screening V.I.2011 [Internet]. cited 2010 Nov 17. Fort Washington: National Comprehensive Cancer Network;Available from: http://www.nccn.org/professionals/physician_gls/PDF/cervical_screening.pdf.

52. Ronco G, Giorgi-Rossi P, Carozzi F, Confortini M, Dalla Palma P, Del Mistro A, et al. Efficacy of human papillomavirus testing for the detection of invasive cervical cancers and cervical intraepithelial neoplasia: a randomised controlled trial. Lancet Oncol. 2010. 11:249–257.

53. Anttila A, Kotaniemi-Talonen L, Leinonen M, Hakama M, Laurila P, Tarkkanen J, et al. Rate of cervical cancer, severe intraepithelial neoplasia, and adenocarcinoma in situ in primary HPV DNA screening with cytology triage: randomised study within organised screening programme. BMJ. 2010. 340:c1804.

54. Gok M, Heideman DA, van Kemenade FJ, Berkhof J, Rozendaal L, Spruyt JW, et al. HPV testing on self collected cervicovaginal lavage specimens as screening method for women who do not attend cervical screening: cohort study. BMJ. 2010. 340:c1040.

55. Garland SM, Ault KA, Gall SA, Paavonen J, Sings HL, Ciprero KL, et al. Pregnancy and infant outcomes in the clinical trials of a human papillomavirus type 6/11/16/18 vaccine: a combined analysis of five randomized controlled trials. Obstet Gynecol. 2009. 114:1179–1188.

56. Markowitz LE, Dunne EF, Saraiya M, Lawson HW, Chesson H, Unger ER, et al. Quadrivalent human papillomavirus vaccine: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2007. 56:1–24.

57. Wacholder S, Chen BE, Wilcox A, Macones G, Gonzalez P, Befano B, et al. Risk of miscarriage with bivalent vaccine against human papillomavirus (HPV) types 16 and 18: pooled analysis of two randomised controlled trials. BMJ. 2010. 340:c712.

58. Dargent D. Laparoscopic surgery and gynecologic cancer. Curr Opin Obstet Gynecol. 1993. 5:294–300.

59. Querleu D, Leblanc E, Castelain B. Laparoscopic pelvic lymphadenectomy in the staging of early carcinoma of the cervix. Am J Obstet Gynecol. 1991. 164:579–581.

60. Childers JM, Spirtos NM, Brainard P, Surwit EA. Laparoscopic staging of the patient with incompletely staged early adenocarcinoma of the endometrium. Obstet Gynecol. 1994. 83:597–600.

61. Spirtos NM, Schlaerth JB, Spirtos TW, Schlaerth AC, Indman PD, Kimball RE. Laparoscopic bilateral pelvic and paraaortic lymph node sampling: an evolving technique. Am J Obstet Gynecol. 1995. 173:105–111.

62. Walker JL, Piedmonte MR, Spirtos NM, Eisenkop SM, Schlaerth JB, Mannel RS, et al. Laparoscopy compared with laparotomy for comprehensive surgical staging of uterine cancer: Gynecologic Oncology Group Study LAP2. J Clin Oncol. 2009. 27:5331–5336.

63. Kornblith AB, Huang HQ, Walker JL, Spirtos NM, Rotmensch J, Cella D. Quality of life of patients with endometrial cancer undergoing laparoscopic international federation of gynecology and obstetrics staging compared with laparotomy: a Gynecologic Oncology Group study. J Clin Oncol. 2009. 27:5337–5342.

64. Janda M, Gebski V, Brand A, Hogg R, Jobling TW, Land R, et al. Quality of life after total laparoscopic hysterectomy versus total abdominal hysterectomy for stage I endometrial cancer (LACE): a randomised trial. Lancet Oncol. 2010. 11:772–780.

65. Mourits MJ, Bijen CB, Arts HJ, ter Brugge HG, van der Sijde R, Paulsen L, et al. Safety of laparoscopy versus laparotomy in early-stage endometrial cancer: a randomised trial. Lancet Oncol. 2010. 11:763–771.

66. Creutzberg CL, van Putten WL, Koper PC, Lybeert ML, Jobsen JJ, Warlam-Rodenhuis CC, et al. Surgery and postoperative radiotherapy versus surgery alone for patients with stage-1 endometrial carcinoma: multicentre randomised trial. PORTEC Study Group. Post Operative Radiation Therapy in Endometrial Carcinoma. Lancet. 2000. 355:1404–1411.

67. Scholten AN, van Putten WL, Beerman H, Smit VT, Koper PC, Lybeert ML, et al. Postoperative radiotherapy for Stage 1 endometrial carcinoma: long-term outcome of the randomized PORTEC trial with central pathology review. Int J Radiat Oncol Biol Phys. 2005. 63:834–838.

68. Keys HM, Roberts JA, Brunetto VL, Zaino RJ, Spirtos NM, Bloss JD, et al. A phase III trial of surgery with or without adjunctive external pelvic radiation therapy in intermediate risk endometrial adenocarcinoma: a Gynecologic Oncology Group study. Gynecol Oncol. 2004. 92:744–751.

69. Nout RA, Smit VT, Putter H, Jurgenliemk-Schulz IM, Jobsen JJ, Lutgens LC, et al. Vaginal brachytherapy versus pelvic external beam radiotherapy for patients with endometrial cancer of high-intermediate risk (PORTEC-2): an open-label, non-inferiority, randomised trial. Lancet. 2010. 375:816–823.

70. Kitchener H, Swart AM, Qian Q, Amos C, Parmar MK. ASTEC Study Group. Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. Lancet. 2009. 373:125–136.

71. Benedetti Panici P, Basile S, Maneschi F, Alberto Lissoni A, Signorelli M, Scambia G, et al. Systematic pelvic lymphadenectomy vs. no lymphadenectomy in early-stage endometrial carcinoma: randomized clinical trial. J Natl Cancer Inst. 2008. 100:1707–1716.

72. Yaegashi N, Ito K, Niikura H. Lymphadenectomy for endometrial cancer: is paraaortic lymphadenectomy necessary? Int J Clin Oncol. 2007. 12:176–180.

73. Frederick PJ, Straughn JM Jr. The role of comprehensive surgical staging in patients with endometrial cancer. Cancer Control. 2009. 16:23–29.

74. Todo Y, Kato H, Kaneuchi M, Watari H, Takeda M, Sakuragi N. Survival effect of para-aortic lymphadenectomy in endometrial cancer (SEPAL study): a retrospective cohort analysis. Lancet. 2010. 375:1165–1172.

75. Mariani A, Dowdy SC, Cliby WA, Gostout BS, Jones MB, Wilson TO, et al. Prospective assessment of lymphatic dissemination in endometrial cancer: a paradigm shift in surgical staging. Gynecol Oncol. 2008. 109:11–18.

76. Yokoyama Y, Maruyama H, Sato S, Saito Y. Indispensability of pelvic and paraaortic lymphadenectomy in endometrial cancers. Gynecol Oncol. 1997. 64:411–417.

77. Niikura H, Okamura C, Utsunomiya H, Yoshinaga K, Akahira J, Ito K, et al. Sentinel lymph node detection in patients with endometrial cancer. Gynecol Oncol. 2004. 92:669–674.

78. Extermann M. Geriatric oncology: an overview of progresses and challenges. Cancer Res Treat. 2010. 42:61–68.

79. Smorenburg CH, ten Tije AJ, Verweij J, Bontenbal M, Mross K, van Zomeren DM, et al. Altered clearance of unbound paclitaxel in elderly patients with metastatic breast cancer. Eur J Cancer. 2003. 39:196–202.

80. Bouchardy C, Rapiti E, Blagojevic S, Vlastos AT, Vlastos G. Older female cancer patients: importance, causes, and consequences of undertreatment. J Clin Oncol. 2007. 25:1858–1869.

81. Petignat P, Fioretta G, Verkooijen HM, Vlastos AT, Rapiti E, Bouchardy C, et al. Poorer survival of elderly patients with ovarian cancer: a population-based study. Surg Oncol. 2004. 13:181–186.

82. Bruchim I, Altaras M, Fishman A. Age contrasts in clinical characteristics and pattern of care in patients with epithelial ovarian cancer. Gynecol Oncol. 2002. 86:274–278.

83. Hershman D, Fleischauer AT, Jacobson JS, Grann VR, Sundararajan V, Neugut AI. Patterns and outcomes of chemotherapy for elderly patients with stage II ovarian cancer: a population-based study. Gynecol Oncol. 2004. 92:293–299.

84. Maas HA, Kruitwagen RF, Lemmens VE, Goey SH, Janssen-Heijnen ML. The influence of age and co-morbidity on treatment and prognosis of ovarian cancer: a population-based study. Gynecol Oncol. 2005. 97:104–109.

85. Schrijvers D, Baitar A, Vos MD, Mebis J, Vroman P. Evaluation of the groningen frailty index (GFI) as a screening tool in elderly patients (PTS): an interim analysis. In : 2010 ESMO; Abstract 566PD.

86. Extermann M, Boler I, Reich R, Lyman GH, Brown RH, DeFelice J, et al. The chemotherapy risk assessment scale for high-age patients (CRASH) score: design and validation. In : 2010 ASCO Annual Meeting; Abstract 9000.

87. Hurria A, Togawa K, Mohile SG, Owusu C, Klepin HD, Gross C, et al. Predicting chemotherapy toxicity in older adults with cancer: a prospective 500 patient multicenter study. In : 2010 ASCO Annual Meeting; Abstract 9001.

88. McCluggage WG. Uterine carcinosarcomas (malignant mixed Mullerian tumors) are metaplastic carcinomas. Int J Gynecol Cancer. 2002. 12:687–690.

89. D'Angelo E, Prat J. Uterine sarcomas: a review. Gynecol Oncol. 2010. 116:131–139.

90. Prat J. FIGO staging for uterine sarcomas. Int J Gynaecol Obstet. 2009. 104:177–178.

91. Homesley HD, Filiaci V, Markman M, Bitterman P, Eaton L, Kilgore LC, et al. Phase III trial of ifosfamide with or without paclitaxel in advanced uterine carcinosarcoma: a Gynecologic Oncology Group Study. J Clin Oncol. 2007. 25:526–531.

92. Sutton GP, Blessing JA, Rosenshein N, Photopulos G, DiSaia PJ. Phase II trial of ifosfamide and mesna in mixed mesodermal tumors of the uterus (a Gynecologic Oncology Group study). Am J Obstet Gynecol. 1989. 161:309–312.

93. Sutton G, Brunetto VL, Kilgore L, Soper JT, McGehee R, Olt G, et al. A phase III trial of ifosfamide with or without cisplatin in carcinosarcoma of the uterus: A Gynecologic Oncology Group Study. Gynecol Oncol. 2000. 79:147–153.

94. Slayton RE, Blessing JA, DiSaia PJ, Christopherson WA. Phase II trial of etoposide in the management of advanced or recurrent mixed mesodermal sarcomas of the uterus: a Gynecologic Oncology Group Study. Cancer Treat Rep. 1987. 71:661–662.

95. Omura GA, Major FJ, Blessing JA, Sedlacek TV, Thigpen JT, Creasman WT, et al. A randomized study of adriamycin with and without dimethyl triazenoimidazole carboxamide in advanced uterine sarcomas. Cancer. 1983. 52:626–632.

96. Thigpen JT, Blessing JA, Orr JW Jr, DiSaia PJ. Phase II trial of cisplatin in the treatment of patients with advanced or recurrent mixed mesodermal sarcomas of the uterus: a Gynecologic Oncology Group Study. Cancer Treat Rep. 1986. 70:271–274.

97. Curtin JP, Blessing JA, Soper JT, DeGeest K. Paclitaxel in the treatment of carcinosarcoma of the uterus: a gynecologic oncology group study. Gynecol Oncol. 2001. 83:268–270.

98. Powell MA, Filiaci VL, Rose PG, Mannel RS, Hanjani P, Degeest K, et al. Phase II evaluation of paclitaxel and carboplatin in the treatment of carcinosarcoma of the uterus: a Gynecologic Oncology Group study. J Clin Oncol. 2010. 28:2727–2731.