Details

Autor(en) / Beteiligte

• Cybulska, Paulina
• Sioulas, Vasileios
• Orfanelli, Theofano
• Zivanovic, Oliver
• Mueller, Jennifer J.
• Broach, Vance A.
• Long Roche, Kara C.
• Sonoda, Yukio
• Hensley, Martee L.
• O'Cearbhaill, Roisin E.
• Chi, Dennis S.
• Alektiar, Kaled M.
• Abu-Rustum, Nadeem R.
• Leitao, Mario M.

Titel

Secondary surgical resection for patients with recurrent uterine leiomyosarcoma

Ist Teil von

• Gynecologic oncology, 2019-08, Vol.154 (2), p.333-337

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2019

Quelle

MEDLINE

Beschreibungen/Notizen

• To assess outcomes after secondary surgical resection in patients with recurrent uterine leiomyosarcoma (uLMS). We retrospectively identified all patients who had no evidence of disease after initial surgery for uLMS, who underwent surgery for a first recurrence at our institution between 1/1991 and 10/2013. We excluded patients who received any therapy for recurrence prior to secondary resection, and patients who underwent surgery soon after morcellation [of presumed benign fibroids] showed widespread disease. Overall survival (OS) was determined from time of first recurrence to death or last follow-up. We identified 62 patients: 29 with abdominal/pelvic recurrence only, 30 with lung recurrence only, 3 with both. Median time to first recurrence was 18 months (95% CI: 13.3–23.3): 15.8 months (95% CI: 13.0–18.6) abdominal/pelvic recurrence; 24.1 months (95% CI: 14.5–33.7) lung-only recurrence (p = 0.03). Median OS was 37.7 months (95% CI: 25.9–49.6) abdominal/pelvic recurrence; 78.1 months (95% CI: 44.8–11.4) lung recurrence (p = 0.02). Complete gross resection (CGR) was achieved in 58 cases (93%), with gross residual ≤1 cm in 2 (3.5%) and >1 cm in 2 (3.5%). Median OS based on residual disease was 54.1 months (95% CI: 24.9–83.3), 38.7 months (95% CI: NE), 1.7 months (95% CI: NE), respectively (p < 0.001). In cases with CGR, neither adjuvant radiation (N = 9), chemotherapy (N = 8) nor hormonal therapy (N = 10) was associated with improved OS. Secondary surgical resection of recurrent uLMS is reasonable in patients with a high probability of achieving CGR. Lung-only recurrences were associated with more favorable outcome. Following CGR, additional therapy may not offer benefit. •Data regarding optimal management of recurrent uterine leiomyosarcoma are scant.•Secondary surgical resection should be considered if there is high probability of CGR.•Compared to abdominal/pelvic recurrences, lung-only recurrences have better outcomes.•Following complete resection, systemic therapy or radiation may not offer benefit.