Surgical cytoreduction in patients with metastatic uterine leiomyosarcoma at the time of initial diagnosis Journal Article

Authors: Leitao, M. M. Jr; Zivanovic, O.; Chi, D. S.; Hensley, M. L.; O'cearbhaill, R.; Soslow, R. A.; Barakat, R. R.
Article Title: Surgical cytoreduction in patients with metastatic uterine leiomyosarcoma at the time of initial diagnosis
Abstract: Objective: To determine whether cytoreduction is associated with improved outcome in patients newly diagnosed with metastatic uterine leiomyosarcoma (LMS). Methods: We retrospectively identified all patients treated at our institution for high-grade uterine LMS with extrauterine disease at the time of initial diagnosis from 7/1/82 to 7/31/07. Pattern of disease spread was classified as intraperitoneal (IP) or extraperitoneal (EP). Progression-free survival (PFS) and overall survival (OS) were determined from date of initial surgery using Kaplan-Meier estimates. Results: We identified 96 cases. Median age was 54 years (range, 23-81). IP disease was seen in 48 (50%) and EP in 48 (50%). A complete gross resection of all tumor was achieved in 41/84 (49%). Recurrence or progression was noted in 93 (97%); 81 (84%) have died. Median PFS and OS for the entire cohort was 9.7 months (range, 6.7-10.9) and 20.2 months (range, 15.5-24.8), respectively. All 8 non-surgical cases died within 30 months of diagnosis. Median PFS was 14.2 months (range, 11.4-16.9) for those with a complete gross resection versus 6.8 months (range, 4.1-9.5) for those with any residual disease (P = 0.002). Median OS was 31.9 months (range, 3.3-60.4) versus 20.2 months (range, 11.8-28.6), respectively (P = 0.04). On multivariate analysis, no residual disease was independently associated with PFS when adjusting for disease distribution (IP vs EP) and the use of chemotherapy but not OS. Conclusions: Surgical cytoreduction of metastatic uterine LMS was independently associated with PFS but not OS in cases selected for surgery. The improvement in PFS must be weighed against the morbidity of surgery. © 2012 Elsevier Inc. All rights reserved.
Keywords: metastasis; outcome; surgery; cytoreduction; uterine leiomyosarcoma
Journal Title: Gynecologic Oncology
Volume: 125
Issue: 2
ISSN: 0090-8258
Publisher: Elsevier Inc.  
Date Published: 2012-05-01
Start Page: 409
End Page: 413
Language: English
DOI: 10.1016/j.ygyno.2012.02.014
PROVIDER: scopus
PUBMED: 22366592
Notes: --- - "Export Date: 1 May 2012" - "CODEN: GYNOA" - "Source: Scopus"
Citation Impact
MSK Authors
  1. Richard R Barakat
    629 Barakat
  2. Dennis S Chi
    536 Chi
  3. Mario Leitao
    375 Leitao
  4. Martee L Hensley
    241 Hensley
  5. Robert Soslow
    718 Soslow