The role of adjuvant therapy in uterine leiomyosarcoma

Ducie, J.A.; Leitao, Mario M.

doi:10.1586/14737140.2016.1115724

Cited by 25 publications

(22 citation statements)

References 67 publications

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“…In 2018, Friedman and Hensley [22] published an interesting review on uterine LMS and concluded that neither adjuvant radiotherapy nor chemotherapy affects the prognosis of uterineconfined, completely resected LMS. The review by Ducie et al [23] reached the same conclusion; Ducie et al reported that there was also no proven benefit of chemotherapy for completely resected advanced stages of the disease, although it was commonly considered. They also reported that doxorubicin, with or without other agents, had been chosen as an adjuvant treatment because of its success in achieving a 30% response in measurable disease and that years later, the combination of gemcitabine/docetaxel had become the favoured protocol, as it achieved response rates that could reach 53%.…”

Section: Discussionmentioning

confidence: 90%

Uterine Carcinosarcomas versus Leiomyosarcomas: DuaL Institutional Experience from Mansoura and Zagazig Universities

Halim

Abo-Touk

Mokhtar

et al. 2019

JCTI

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Objective: Carcinosarcomas (CSs) and leiomyosarcomas (LMSs) are rare uterine cancers with high mortality. This study presents a dual institutional experience from two different university teaching hospitals (Mansoura and Zagazig Universities situated in the Delta of the Nile River in Egypt) with regard to the treatment modalities of those two types of uterine cancers aimed at establishing demographics and treatment outcomes. Patients & Methods: The data from 12 uterine CS and 17 LMS patients treated at the Clinical Oncology Departments of Mansoura and Zagazig Universities from January 2012 to June 2018 were reviewed to evaluate demographics and treatment outcomes. Results: The mean age of the patients was greater than 50 years. Abnormal uterine bleeding (AUB) was the most common presenting symptom. Six CS (50%) patients underwent comprehensive surgical staging, while 4 patients underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH&BSO). Conversely, TAH&BSO was performed in 15 patients with LMS (88%). Adjuvant radiotherapy was given to 6 CS (50%) and 4 LMS (24%) patients. Meanwhile, adjuvant chemotherapy was received by 5 CS (42%) and 8 LMS (47%) patients. Pelvic failure occurred in only the LMS group. Visceral metastasis occurred in both groups, while bone metastasis was encountered in only the CS group. The overall survival at 5 years was 53% and 32% in patients with CS and LMS, respectively. Conclusion: AUB should be seriously investigated. Both diseases are aggressive despite early presentation and radical multimodality treatment. Local recurrence was reported in only the LMS group. Visceral metastasis occurred in both groups, unlike bone metastasis. New targeted therapies are urgently needed.

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Section: Discussionmentioning

confidence: 90%

Uterine Carcinosarcomas versus Leiomyosarcomas: DuaL Institutional Experience from Mansoura and Zagazig Universities

Halim

Abo-Touk

Mokhtar

et al. 2019

JCTI

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“…In the present study, we found that CS patients receiving lymphadenectomy had significantly higher OS, in line with the literature. The gold standard of management for LMS is surgery, and patients with suspected or confirmed LMS should have their uterus removed en bloc, with maximal effort to avoid intraoperative rupture or spillage of the tumour into the peritoneal cavity [15]. The incidence of retroperitoneal lymph node metastases is low for LMS; therefore, pelvic and paraaortic lymph node dissection is not recommended in routine practice, even for patients who have been found to have lymph node involvement [16].…”

Section: Discussionmentioning

confidence: 99%

Uterine sarcomas: clinical characteristics, management, and outcomes – a single centre’s experience

Erdem¹,

Besimoğlu²,

Yıldırım³

et al. 2018

Arch Med Sci Civil Dis

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Introduction: The purpose of the present study is to evaluate the clinical presentation, histopathologic pattern and outcome of uterine sarcomas in a single institution of gynaecological oncology. Material and methods: The database of the Gynecologic Oncology Department of the hospital was used to identify patients diagnosed with pathological uterine sarcoma treated between January 1, 2004, and December 31, 2015. We collected clinicopathological data to evaluate factors that are important for overall survival (OS). Results: A total of 54 cases were included in the analysis: 25 uterine leiomyosarcomas (LMS), 19 carcinosarcomas (CS) and nine endometrial stromal sarcomas (ESS). The mean age was 53.8 years for LMS, 62.1 years for CS. Disease recurrence occurred in 13 (24.0%) patients. The recurrent disease occurred in the pelvis in nine patients, but it was characterised by distant metastases (liver or mediastinal lymph nodes) in the other four patients Having had a lymphadenectomy and adjuvant chemotherapy for CS and advanced stage for LMS were the only factors for which a significant difference in OS was observed (p = 0.035, p = 0.006 and p = 0.04, respectively). In contrast, for CS, only not having adjuvant chemotherapy showed a significant association with poor disease free survival. Conclusions: Lymphadenectomy and adjuvant chemotherapy had a significant impact on OS for CS, and advanced stage was the only independent predictor of OS for LMS.

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“…After a thorough bibliographic examination, the patient was interviewed to schedule the most appropriate follow-up and to discuss potential adjuvant therapy. The efficacy of systemic adjuvant therapy (15) and intraperitoneal hyperthermia is unclear, and there is no evidence for an absolute benefit of adjuvant therapy compared with surgery alone (16,17,18). Therefore, with the patient's agreement, given the high probability of disease recurrence, we decided on a follow up consisting…”

Section: Case Reportmentioning

confidence: 99%

Long-Term Survival in a Patient With Abdominal Sarcomatosis From Uterine Leiomyosarcoma: Role of Repeated Laparoscopic Surgery in Treatment and Follow-Up

Macciò

Kotsonis

Chiappe

et al. 2016

Journal of Minimally Invasive Gynecology

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Uterine leiomyosarcoma (LMS) in some cases may disseminate through the abdominal cavity, without extra-abdominal spreading, determining a condition of abdominal sarcomatosis, which represents a peculiar situation. Only radical surgical removal offers a chance of long-term survival in such cases of LMS. Here we describe a case of diffuse abdominal sarcomatosis from uterine LMS in a 51-year-old perimenopausal woman who underwent laparoscopic radical hysterectomy, bilateral salpingo-oophorectomy, total pelvic peritonectomy, pelvic lymphadenectomy to the mesenteric inferior artery, and omentectomy. Then, given the high probability of disease recurrence, the patient underwent a close follow-up consisting of positron emission tomography (PET)/computed tomography every 3 months and diagnostic (and if necessary operative) laparoscopy every 6 months. To date, the patient had 11 laparoscopies; 5 of them were preceded by a PET indicative of the presence of disease with high metabolic activity, which was confirmed at surgery and each time completely removed laparoscopically with no evidence of residual disease. To date, 5 years from diagnosis the patient is alive and continues her follow-up. Our report brings to light the ability of laparoscopic surgery to obtain disease control in a case of LMS with abdominal dissemination. Moreover, laparoscopic surgery, as demonstrated in our case, may have an important role in the close follow-up of the disease and allow a timely and early radical surgical approach of relapses before they become extremely large and difficult to remove radically.

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The role of adjuvant therapy in uterine leiomyosarcoma

Cited by 25 publications

References 67 publications

Uterine Carcinosarcomas versus Leiomyosarcomas: DuaL Institutional Experience from Mansoura and Zagazig Universities

Uterine Carcinosarcomas versus Leiomyosarcomas: DuaL Institutional Experience from Mansoura and Zagazig Universities

Uterine sarcomas: clinical characteristics, management, and outcomes – a single centre’s experience

Long-Term Survival in a Patient With Abdominal Sarcomatosis From Uterine Leiomyosarcoma: Role of Repeated Laparoscopic Surgery in Treatment and Follow-Up

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