Gynecologic Cancer InterGroup (GCIG) Consensus Review: Uterine and Ovarian Leiomyosarcomas

Abstract

Objective The GCIG aimed to provide an overview of uterine and ovarian leiomyosarcoma management. Methods Published articles and author experience were used to draft management overview. The draft manuscript was circulated to international members of the GCIG for review and comment, and appropriate revisions were made. Results The approach to management of uterine and ovarian leiomyosarcoma management is reviewed. Conclusions Uterine and ovarian leiomyosarcomas are rare, aggressive cancers that require specialized expertise for optimal management.

Gemcitabine and Docetaxel Compared With Observation, Radiation, or Other Chemotherapy Regimens as Adjuvant Treatment for Stage I-to-IV Uterine Leiomyosarcoma

“…For patients with disease limited to the uterus or those with disease that seems to be completely resectable, hysterectomy with complete tumor debulking should be the initial goal of care. 12 In our study, complete cytoreduction was associated with improved PFS, which is consistent with findings by Leitao et al 6 However, we also found that cytoreduction to no residual disease was also associated with improved OS. Thus, surgery should be undertaken with the goal of no residual disease.…”

“…Conversely, our findings also support the notion that the role of surgery is much more limited in patients who present with widely metastatic and unresectable disease, unless the procedure is being performed for palliation. 12 Beyond the initial surgery, the current prospective data are insufficient to guide management recommendations for either uterus-limited disease or locally advanced, completely resected uLMS. A randomized trial looking at adjuvant pelvic radiation versus observation in patients with uterine-limited disease failed to demonstrate any difference in survival or recurrence rates in the radiation arm, 13 thus suggesting that radiation may have a limited role in this setting.…”

“…Currently, the available data cannot be used to support a recommendation for adjuvant chemotherapy as standard treatment given the heterogeneity of the tumor types and stages, the small cohort sizes, and no OS benefit. 12 Therefore, given the paucity of data, the rarity of this disease, and the lack of control arms in the trials that have shown promising outcomes with gem-doc, we sought to compare the impact of this doublet chemotherapeutic regimen to other treatment options in the adjuvant setting. Our study objective was to compare PFS and OS among patients with uLMS who underwent adjuvant treatment with gem-doc versus those who were assigned to observation, another chemotherapeutic regimen, or radiation postoperatively.…”

Role of Lymphadenectomy for Uterine Sarcoma: A Meta-Analysis

“…Although Tangjitgamol et al 41 concluded that lymph node size was not a good predictor of lymph node metastases in uterine cancer, removing the enlarged lymph nodes in uLMS was considerable. 42 Pelvic and/or paraaortic lymph node dissection was not routinely recommended by most authors since retroperitoneal involvement was found to be rare in their sample. 11 The low incidence of lymph node metastasis is similar to those women with uLMS of other soft tissues.…”

Immunohistochemical panel to differentiate endometrial stromal sarcoma, uterine leiomyosarcoma and leiomyoma: something old and something new

“…ULMS and ESS can show LG and high grade features, a factor that can play a role in histological diagnosis, but is not necessarily used for classification 6 8 9. Distinguishing ESS from ULMS, as well as LG tumours and LM from LG uterine sarcomas (ESS and ULMS), is usually straightforward, particularly on a hysterectomy specimen.…”