Synapse - Secondary surgical resection for patients with recurrent uterine leiomyosarcoma

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
DOI/URL:	https://www.scopus.com/inward/record.uri?eid=2-s2.0-85067082370&doi=10.1016%2fj.ygyno.2019.05.015&partnerID=40&md5=437a76719f7685ea5b9139d7f8c71a75
Notes:	Article -- Export Date: 2 August 2019 -- Source: Scopus