Introduction
This systematic review focused on rare histological types of corpus uteri malignancy, including uterine carcinosarcoma (UCS), uterine clear cell carcinoma (UCCC), and uterine papillary serous carcinoma (UPSC), and it is proposed to assist with clinical decision-making. Adjuvant treatment decisions must be made based on available evidences. We mainly investigated the role of vaginal interventional radiotherapy (VIRt) in UCS, UCCC, and UPSC managements.

Material and methods
A systematic research using PubMed and Cochrane library was conducted to identify full articles evaluating the efficacy of VIRt in early-stage UPSC, UCCC, and UCS. A search in ClinicalTrials.gov was performed in order to detect ongoing or recently completed trials as well as in PROSPERO for ongoing or recently completed systematic reviews. Survival outcomes and toxicity rates were obtained.

Results
All studies were retrospective. For UCS, the number of evaluated patients was 432. The 2- to 5-year average local control (LC) was 91% (range, 74.2-96%), disease-free survival (DFS) 88% (range, 82-94%), overall survival (OS) 79% (range, 53.8-84.3%), the average 5-year cancer-specific survival (CSS) was 70% (range, 70-94%), and G3-G4 toxicity was 0%. For UCCC, the number of investigated patients was 335 (UCCC – 124, mixed – 211), with an average 5-year LC of 100%, DFS of 83% (range, 82-90%), OS of 93% (range, 83-100%), and G3-G4 toxicity of 0%. For UPSC, the number of examined patients was 1,092 (UPSC – 866, mixed – 226). The average 5-year LC was 97% (range, 87.1-100%), DFS 84% (range, 74.7-95.6%), OS 93% (range, 71.9-100%), CSS 89% (range, 78.9-94%), and G3-G4 toxicity was 0%.

Conclusions
These data suggest that in adequately selected early-stage UPSC and UCCC patients, VIRt alone may be suitable in women who underwent surgical staging and received adjuvant chemotherapy. In early-stage UCS, a multidisciplinary therapeutic approach has to be planned, considering high-rate of pelvic and distant relapses.



中文翻译：

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早期非子宫内膜样癌的辅助阴道介入放疗：系统评价

引言
本系统评价侧重于罕见的子宫体恶性肿瘤组织学类型，包括子宫癌肉瘤 (UCS)、子宫透明细胞癌 (UCCC) 和子宫乳头状浆液性癌 (UPSC)，旨在协助临床决策。必须根据现有证据做出辅助治疗决定。我们主要研究了阴道介入放疗 (VIRt) 在 UCS、UCCC 和 UPSC 管理中的作用。

材料与方法
使用 PubMed 和 Cochrane 图书馆进行了一项系统研究，以确定评估 VIRt 在早期 UPSC、UCCC 和 UCS 中疗效的完整文章。在 ClinicalTrials.gov 中进行搜索以检测正在进行或最近完成的试验，并在 PROSPERO 中搜索正在进行或最近完成的系统评价。获得了生存结果和毒性率。

结果
所有研究均为回顾性研究。对于 UCS，评估的患者人数为 432。2 至 5 年平均局部控制 (LC) 为 91%（范围，74.2-96%），无病生存率 (DFS) 88%（范围，82- 94%），总生存期（OS）79%（范围，53.8-84.3%），平均 5 年癌症特异性生存率（CSS）为 70%（范围，70-94%），G3-G4 毒性为0%。对于 UCCC，研究的患者人数为 335（UCCC – 124，混合 – 211），平均 5 年 LC 为 100%，DFS 为 83%（范围，82-90%），OS 为 93%（范围, 83-100%)，而 G3-G4 毒性为 0%。对于 UPSC，接受检查的患者人数为 1,092（UPSC – 866，混合 – 226）。平均 5 年 LC 为 97%（范围，87.1-100%），DFS 84%（范围，74.7-95.6%），OS 93%（范围，71.9-100%），CSS 89%（范围，78.9- 94%)，G3-G4 毒性为 0%。

结论
这些数据表明，在充分选择的早期 UPSC 和 UCCC 患者中，单独的 VIRt 可能适用于接受手术分期并接受辅助化疗的女性。在早期 UCS 中，考虑到盆腔和远处复发率高，必须计划多学科治疗方法。