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Geburtshilfe Frauenheilkd 2011; 71(12): 1085-1089
DOI: 10.1055/s-0031-1280462
Original Article
GebFra Science
Georg Thieme Verlag KG Stuttgart · New York

Clinical Characteristics, Surgical Management and Adjuvant Therapy of Patients with Uterine Leiomyosarcoma: 27 Years of Experience

Klinische Charakteristika, operatives Management und adjuvante Therapie von Patientinnen mit uterinen Leiomyosarkomen: Erfahrungen der letzten 27 Jahre
R. Rothmund   *
1   Department of Obstetrics and Gynecology, University of Tuebingen, Tuebingen
,
M. Huebner   *
1   Department of Obstetrics and Gynecology, University of Tuebingen, Tuebingen
,
C. Joachim
1   Department of Obstetrics and Gynecology, University of Tuebingen, Tuebingen
,
A. Hartkopf
1   Department of Obstetrics and Gynecology, University of Tuebingen, Tuebingen
,
T. Fehm
1   Department of Obstetrics and Gynecology, University of Tuebingen, Tuebingen
,
M. Bamberg
2   Department of Radiation Oncology, University of Tuebingen, Tuebingen
,
M. Wallwiener
3   Department of Obstetrics and Gynecology, University of Heidelberg, Heidelberg
,
S. Brucker   *
1   Department of Obstetrics and Gynecology, University of Tuebingen, Tuebingen
,
F. A. Taran   *
1   Department of Obstetrics and Gynecology, University of Tuebingen, Tuebingen
› Author Affiliations
Further Information

Publication History

received 23 November 2011
revised 25 November 2011

accepted 03 December 2011

Publication Date:
22 December 2011 (online)

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Abstract

Purpose: To review a single-center experience over a 27-year period in the management of uterine leiomyosarcoma (LMS) for insight into surgical practice, adjuvant therapy and clinical outcome. Material and Methods: This was a retrospective study of women with histologically proven uterine LMS who were treated at the Department of Obstetrics and Gynecology, University of Tuebingen, Germany, between 1983 and 2010. Inpatient and ambulatory records were reviewed; follow-up and survival data were ascertained. Results: The study sample comprised 32 patients with uterine LMS. Primary surgical treatment consisted of total abdominal hysterectomy in 28 patients (88 %) and laparoscopic total hysterectomy in 4 patients (12 %). Lymph nodes were dissected and evaluated in 17 women (53 %); positive lymph nodes were present in 1 patient (6 %). A total of 17 patients (53 %) received adjuvant therapy. Median follow-up for disease-free survival (DFS) was 35.6 months and median DFS was 27.0 months for all patients. The median follow-up for overall survival (OS) was 51.3 months and the median OS was 28.0 months for our study group. The 5-year survival rate was 30 %. There was no significant difference in DFS (p = 0.76) and OS (p = 0.51) between patients who received adjuvant therapy and those who did not. Conclusion: Uterine LMS are rare and aggressive uterine neoplasms with high recurrence rates and metastatic potential. Surgery consisting of total hysterectomy with or without bilateral salpingo-oophorectomy is the most important treatment-element in patients with uterine LMS. Lymphadenectomy should be reserved for patients with clinically suspicious nodes.

Zusammenfassung

Einleitung: Im Folgenden wird die Erfahrung eines Zentrums von 27 Jahren bezüglich des Managements von uterinen Leiomyosarkomen (LMS) mit besonderem Fokus auf operative Techniken, adjuvante Therapie und klinisches Outcome dargestellt. Material und Methoden: Dies ist eine retrospektive Studie von Frauen mit einem histologischen Nachweis eines uterinen LMS, die in der Universitätsfrauenklinik Tübingen zwischen den Jahren 1983 und 2010 therapiert wurden. Sowohl der stationäre Aufenthalt als auch die ambulante Betreuung wurden analysiert, die Überlebensdaten wurden exploriert. Ergebnisse: Die Studienpopulation beinhaltete 32 Patientinnen mit uterinen LMS. Die operative Primärtherapie beinhaltete entweder eine totale abdominale Hysterektomie bei 28 Patientinnen (88 %), oder eine totale laparoskopische Hysterektomie bei 4 Patientinnen (12 %). Lymphonodektomien wurden bei 17 Patientinnen (53 %) durchgeführt, eine Nodalpositivität ergab sich bei einer Patientin (6 %). In Summe erhielten 17 Frauen (53 %) eine adjuvante Therapie. Der mittlere Nachbeobachtungzeitraum für Disease free Survival (DFS) betrug 35.6 Monate, das DFS an sich betrug 27,0 Monate für alle Patientinnen. Der mittlere Nachbeobachtungszeitraum für Overall Survival (OS) betrug 51,3 Monate bei einem mittleren OS von 28,0 Monaten. Das 5-Jahres-Überleben betrug 30 %. Beim Vergleich zwischen den Patientinnen, die eine adjuvante Therapie erhielten und denen ohne diese Therapie fanden sich keine signifikanten Unterschiede im DFS (p = 0,76) und im OS (p = 0,51). Zusammenfassung: Uterine LMS sind seltene und aggressive uterine Neoplasien mit einem hohen Rezidiv- und Metastasierungsrisiko. Die operative Therapie beinhaltet als wichtigstes Element die totale Hysterektomie mit oder ohne beidseitige Adnexektomie. Eine Lymphonodektomie sollte den Fällen mit klinisch auffälligen Lymphknoten vorbehalten sein.

Key words

leiomyosarcoma - uterine neoplasms - lymphadenectomy - adjuvant therapy

Schlüsselwörter

Leiomyosarkom - uterine Neoplasien - Lymphonodektomie - adjuvante Therapie

Footnote

* These authors contributed equally to this work.


 

  • References

  • 1 Echt G, Jepson J, Steel J et al. Treatment of uterine sarcomas. Cancer 1990; 66: 35-39
    CrossrefPubMedGoogle Scholar
  • 2 Bronz L, Genton CY, Kunz J et al. Pure mesenchymal homologous sarcomas of the uterus at the Womenʼs University Hospital, Zürich, 1960–1983. Geburtsh Frauenheilk 1985; 45: 288-293
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Kapp DS, Shin JY, Chan JK. Prognostic factors and survival in 1396 patients with uterine leiomyosarcomas: emphasis on impact of lymphadenectomy and oophorectomy. Cancer 2008; 112: 820-830
    CrossrefPubMedGoogle Scholar
  • 4 Giuntoli 2nd RL, Metzinger DS, DiMarco CS et al. Retrospective review of 208 patients with leiomyosarcoma of the uterus: prognostic indicators, surgical management, and adjuvant therapy. Gynecol Oncol 2003; 89: 460-469
    CrossrefPubMedGoogle Scholar
  • 5 Goppel K, Becker K, Schmalfeldt B et al. Leiomyomatosis peritonealis disseminata – four case reports of a rare disease. Geburtsh Frauenheilk 2009; 69: 945-951
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Taran FA, Weaver AL, Gostout BS et al. Understanding cellular leiomyomas: a case-control study. Am J Obstet Gynecol 2010; 203: 109.e1-109.e6
    PubMedGoogle Scholar
  • 7 Mayerhofer K, Obermair A, Windbichler G et al. Leiomyosarcoma of the uterus: a clinicopathologic multicenter study of 71 cases. Gynecol Oncol 1999; 74: 196-201
    CrossrefPubMedGoogle Scholar
  • 8 Krämer B, Wallwiener D, Hönig A et al. Giant fibroids are suspicious for malignancy. Geburtsh Frauenheilk 2003; 63: 160-162
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 Amant F, Coosemans A, Debiec-Rychter M et al. Clinical management of uterine sarcomas. Lancet Oncol 2009; 10: 1188-1198
    CrossrefPubMedGoogle Scholar
  • 10 Salfelder A, Gallinat A, Möller CP et al. Morcellation-associated morbidity after laparoscopic myomectomy and hysterectomy – five case reports of parasitic myomas, endometriosis and unexpected malignancy. Geburtsh Frauenheilk 2009; 69: 940-944
    Article in Thieme ConnectPubMedGoogle Scholar
  • 11 Park JY, Park SK, Kim DY et al. The impact of tumor morcellation during surgery on the prognosis of patients with apparently early uterine leiomyosarcoma. Gynecol Oncol 2011; 122: 255-259
    CrossrefPubMedGoogle Scholar
  • 12 Seddon BM, Davda R. Uterine sarcomas – recent progress and future challenges. Eur J Radiol 2011; 78: 30-40
    CrossrefPubMedGoogle Scholar
  • 13 Park JY, Kim DY, Suh DS et al. Prognostic factors and treatment outcomes of patients with uterine sarcoma: analysis of 127 patients at a single institution, 1989–2007. J Cancer Res Clin Oncol 2008; 134: 1277-1287
    CrossrefPubMedGoogle Scholar
  • 14 Giuntoli 2nd RL, Garrett-Mayer E, Bristow RE et al. Secondary cytoreduction in the management of recurrent uterine leiomyosarcoma. Gynecol Oncol 2007; 106: 82-88
    CrossrefPubMedGoogle Scholar
  • 15 Hoffmann W, Schmandt S, Kortmann RD et al. Radiotherapy in the treatment of uterine sarcomas. A retrospective analysis of 54 cases. Gynecol Obstet Invest 1996; 42: 49-57
    CrossrefPubMedGoogle Scholar
  • 16 Omura GA, Blessing JA, Major F et al. A randomized clinical trial of adjuvant adriamycin in uterine sarcomas: a Gynecologic Oncology Group Study. J Clin Oncol 1985; 3: 1240-1245
    PubMedGoogle Scholar
  • 17 Reed NS, Mangioni C, Malmstrom H et al. Phase III randomised study to evaluate the role of adjuvant pelvic radiotherapy in the treatment of uterine sarcomas stages I and II: an European Organisation for Research and Treatment of Cancer Gynaecological Cancer Group Study (protocol 55874). Eur J Cancer 2008; 44: 808-818
    CrossrefPubMedGoogle Scholar
  • 18 Petru E. Changes of the FIGO staging of gynecologic malignancies 2009. Geburtsh Frauenheilk 2010; 70: 269-272
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Kahanpaa KV, Wahlstrom T, Grohn P et al. Sarcomas of the uterus: a clinicopathologic study of 119 patients. Obstet Gynecol 1986; 67: 417-424
    PubMedGoogle Scholar
  • 20 Van Dinh T, Woodruff JD. Leiomyosarcoma of the uterus. Am J Obstet Gynecol 1982; 144: 817-823
    PubMedGoogle Scholar
  • 21 Livi L, Paiar F, Shah N et al. Uterine sarcoma: twenty-seven years of experience. Int J Radiat Oncol Biol Phys 2003; 57: 1366-1373
    CrossrefPubMedGoogle Scholar
  • 22 Larson B, Silfversward C, Nilsson B et al. Prognostic factors in uterine leiomyosarcoma. A clinical and histopathological study of 143 cases. The Radiumhemmet series 1936–1981. Acta Oncol 1990; 29: 185-191
    CrossrefPubMedGoogle Scholar
  • 23 Loizzi V, Cormio G, Nestola D et al. Prognostic factors and outcomes in 28 cases of uterine leiomyosarcoma. Oncology 2011; 81: 91-97
    CrossrefPubMedGoogle Scholar
  • 24 Barter JF, Smith EB, Szpak CA et al. Leiomyosarcoma of the uterus: clinicopathologic study of 21 cases. Gynecol Oncol 1985; 21: 220-227
    CrossrefPubMedGoogle Scholar
  • 25 Bodner K, Bodner-Adler B, Kimberger O et al. Evaluating prognostic parameters in women with uterine leiomyosarcoma. A clinicopathologic study. J Reprod Med 2003; 48: 95-100
    PubMedGoogle Scholar
  • 26 Gadducci A, Landoni F, Sartori E et al. Uterine leiomyosarcoma: analysis of treatment failures and survival. Gynecol Oncol 1996; 62: 25-32
    CrossrefPubMedGoogle Scholar
  • 27 Hannigan EV, Gomez LG. Uterine leiomyosarcoma. Am J Obstet Gynecol 1979; 134: 557-564
    PubMedGoogle Scholar
  • 28 Blom R, Guerrieri C, Stal O et al. Leiomyosarcoma of the uterus: A clinicopathologic, DNA flow cytometric, p 53, and mdm-2 analysis of 49 cases. Gynecol Oncol 1998; 68: 54-61
    CrossrefPubMedGoogle Scholar
  • 29 Zivanovic O, Leitao MM, Iasonos A et al. Stage-specific outcomes of patients with uterine leiomyosarcoma: a comparison of the International Federation of Gynecology and Obstetrics and American Joint Committee on Cancer Staging Systems. J Clin Oncol 2009; 27: 2066-2072
    CrossrefPubMedGoogle Scholar
  • 30 Nola M, Babic D, Ilic J et al. Prognostic parameters for survival of patients with malignant mesenchymal tumors of the uterus. Cancer 1996; 78: 2543-2550
    CrossrefPubMedGoogle Scholar
  • 31 Kim WY, Chang SJ, Chang KH et al. Uterine leiomyosarcoma: 14-year two-center experience of 31 cases. Cancer Res Treat 2009; 41: 24-28
    CrossrefPubMedGoogle Scholar
  • 32 Aaro LA, Symmonds RE, Dockerty MB. Sarcoma of the uterus. A clinical and pathologic study of 177 cases. Am J Obstet Gynecol 1966; 94: 101-109
    PubMedGoogle Scholar
  • 33 Leitao MM, Sonoda Y, Brennan MF et al. Incidence of lymph node and ovarian metastases in leiomyosarcoma of the uterus. Gynecol Oncol 2003; 91: 209-212
    CrossrefPubMedGoogle Scholar
  • 34 Major FJ, Blessing JA, Silverberg SG et al. Prognostic factors in early-stage uterine sarcoma. A Gynecologic Oncology Group study. Cancer 1993; 71: 1702-1709
    CrossrefPubMedGoogle Scholar
  • 35 Goff BA, Rice LW, Fleischhacker D et al. Uterine leiomyosarcoma and endometrial stromal sarcoma: lymph node metastases and sites of recurrence. Gynecol Oncol 1993; 50: 105-109
    CrossrefPubMedGoogle Scholar
  • 36 George M, Pejovic MH, Kramar A. Uterine sarcomas: prognostic factors and treatment modalities – study on 209 patients. Gynecol Oncol 1986; 24: 58-67
    CrossrefPubMedGoogle Scholar
  • 37 Mahdavi A, Monk BJ, Ragazzo J et al. Pelvic radiation improves local control after hysterectomy for uterine leiomyosarcoma: a 20-year experience. Int J Gynecol Cancer 2009; 19: 1080-1084
    CrossrefPubMedGoogle Scholar
  • 38 Wu TI, Chang TC, Hsueh S et al. Prognostic factors and impact of adjuvant chemotherapy for uterine leiomyosarcoma. Gynecol Oncol 2006; 100: 166-172
    CrossrefPubMedGoogle Scholar
  • 39 Hensley ML, Ishill N, Soslow R et al. Adjuvant gemcitabine plus docetaxel for completely resected stages I–IV high grade uterine leiomyosarcoma: results of a prospective study. Gynecol Oncol 2009; 112: 563-567
    CrossrefPubMedGoogle Scholar