Secondary surgical resection for patients with recurrent uterine leiomyosarcoma Journal Article

Authors: Cybulska, P.; Sioulas, V.; Orfanelli, T.; Zivanovic, O.; Mueller, J. J.; Broach, V. A.; Long Roche, K. C.; Sonoda, Y.; Hensley, M. L.; O'Cearbhaill, R. E.; Chi, D. S.; Alektiar, K. M.; Abu-Rustum, N. R.; Leitao, M. M. Jr
Article Title: Secondary surgical resection for patients with recurrent uterine leiomyosarcoma
Abstract: Objectives: To assess outcomes after secondary surgical resection in patients with recurrent uterine leiomyosarcoma (uLMS). Methods: 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. Results: 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. Conclusions: 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. © 2019 Elsevier Inc.
Keywords: recurrence; uterine leiomyosarcoma; secondary surgery
Journal Title: Gynecologic Oncology
Volume: 154
Issue: 2
ISSN: 0090-8258
Publisher: Elsevier Inc.  
Date Published: 2019-08-01
Start Page: 333
End Page: 337
Language: English
DOI: 10.1016/j.ygyno.2019.05.015
PUBMED: 31200927
PROVIDER: scopus
PMCID: PMC6650305
Notes: Article -- Export Date: 2 August 2019 -- Source: Scopus
Citation Impact
MSK Authors
  1. Dennis S Chi
    588 Chi
  2. Kaled M Alektiar
    286 Alektiar
  3. Yukio Sonoda
    364 Sonoda
  4. Mario Leitao
    433 Leitao
  5. Oliver Zivanovic
    206 Zivanovic
  6. Martee L Hensley
    250 Hensley
  7. Kara Christine Long
    137 Long
  8. Jennifer Jean Mueller
    94 Mueller
  9. Vance Andrew Broach
    49 Broach