Armando Sardi1, Arkadii Sipok2, Dario Baratti3, Marcello Deraco4, Paul Sugarbaker5, George Salti6, Yutaka Yonemura7, Paolo Sammartino8, Olivier Glehen9, Naoual Bakrin10, Teresa P Díaz-Montes11, Vadim Gushchin12. 1. Department of Surgical Oncology, Institute for Cancer Care at Mercy Medical Center, 227 St. Paul Place, Baltimore, MD, 21202, USA. Electronic address: asardi@mdmercy.com. 2. Department of Surgical Oncology, Institute for Cancer Care at Mercy Medical Center, 227 St. Paul Place, Baltimore, MD, 21202, USA. Electronic address: asipok@mdmercy.com. 3. Fondazione IRCCS Istituto Nazionale Dei Tumori di Milano, Department of Surgery, Peritoneal Surface Malignancies Program, Via Venezian, 1, Milano, MI Cap 20133, Italy. Electronic address: dario.baratti@istitutotumouri.mi.it. 4. Fondazione IRCCS Istituto Nazionale Dei Tumori di Milano, Department of Surgery, Peritoneal Surface Malignancies Program, Via Venezian, 1, Milano, MI Cap 20133, Italy. Electronic address: marcello.deraco@istitutotumori.mi.it. 5. Department of Surgery, MedStar Washington Hospital Center, 106 Irving St NW, Washington, DC 20010, USA. Electronic address: paul.sugarbaker@medstar.net. 6. Division of Surgical Oncology, University of Illinois at Chicago Hospital and Health Sciences System, 1740 W Taylor St, Chicago, Illinois, 60612, USA. Electronic address: gsalti@edward.org. 7. Peritoneal Surface Malignancy Center, Kishiwada Tokushukai Hospital, 4-27-1 Kamori-Cho, Kishiwada City, Osaka, 596-8522, Japan. Electronic address: y.yonemura@coda.ocn.ne.jp. 8. Department of Surgery Pietro Valdoni, Sapienza University of Rome, 5 Piazzale Aldo Moro, Rome, 00185, Italy. Electronic address: paolo.sammartino@uniroma1.it. 9. Department of General and Oncologic Surgery, Centre Hospitalier Lyon Sud, 69495, Pierre Bénite, France. Electronic address: olivier.glehen@chu-lyon.fr. 10. Department of General and Oncologic Surgery, Centre Hospitalier Lyon Sud, 69495, Pierre Bénite, France. Electronic address: naoual.bakrin@chu-lyon.fr. 11. Department of Surgical Oncology, Institute for Cancer Care at Mercy Medical Center, 227 St. Paul Place, Baltimore, MD, 21202, USA. Electronic address: tdiaz@mdmercy.com. 12. Department of Surgical Oncology, Institute for Cancer Care at Mercy Medical Center, 227 St. Paul Place, Baltimore, MD, 21202, USA. Electronic address: vgushchin@mdmercy.com.
Abstract
OBJECTIVE: Uterine sarcoma (US) is a rare tumor representing 1% of female genital tract malignancies. Peritoneal sarcomatosis (PS) after US, diminishes median overall survival (OS) and progression-free survival (PFS) with cytoreductive surgery (CRS) alone, with or without systemic chemotherapy is <1 year and 6 months, respectively. A multi-institutional review of PS from US was conducted to evaluate CRS and hyperthermic intraperitoneal chemotherapy (HIPEC) and effects on survival outcomes. METHODS: A retrospective review of 36 patients from 7 specialized international centers was performed. Selection criteria included PS of uterine origin with CRS/HIPEC treatment. Clinical data were analyzed. OS and PFS were estimated with Kaplan-Meier method. RESULTS: Thirty-six patients underwent a total 38 HIPEC procedures performed from 2005 to 2014; 35 previous treatment and 1 primary treatment. Twenty-nine (81%) LMS patients, 3 (8%) endometrial stromal sarcoma (ESS), 3 (8%) adeneosarcoma (AS), and 1 (3%) categorized as other. Median PCI was 16 (range: 2-39), 10 patients had PCI ≥20. Thirty-four patients (94%) had complete cytoreduction (CC 0-1), 19 patients recurred. CRS/HIPEC OS at 1, 3, and 5-years was 75%, 53%, and 32% respectively, with median OS of 37 months (CI 95%: 20-54). PFS in 32 patients with CC at 1, 3, and 5-years was 67%, 32% and 32%, respectively with median PFS of 18.9 months (CI 95%: 6.7-31). CONCLUSIONS: CRS/HIPEC is a promising treatment modality for patients with PS. Histological subtype may influence survival. A global prospective registry of patients to further assess the efficacy of CRS/HIPEC is needed.
OBJECTIVE: Uterine sarcoma (US) is a rare tumor representing 1% of female genital tract malignancies. Peritoneal sarcomatosis (PS) after US, diminishes median overall survival (OS) and progression-free survival (PFS) with cytoreductive surgery (CRS) alone, with or without systemic chemotherapy is <1 year and 6 months, respectively. A multi-institutional review of PS from US was conducted to evaluate CRS and hyperthermic intraperitoneal chemotherapy (HIPEC) and effects on survival outcomes. METHODS: A retrospective review of 36 patients from 7 specialized international centers was performed. Selection criteria included PS of uterine origin with CRS/HIPEC treatment. Clinical data were analyzed. OS and PFS were estimated with Kaplan-Meier method. RESULTS: Thirty-six patients underwent a total 38 HIPEC procedures performed from 2005 to 2014; 35 previous treatment and 1 primary treatment. Twenty-nine (81%) LMSpatients, 3 (8%) endometrial stromal sarcoma (ESS), 3 (8%) adeneosarcoma (AS), and 1 (3%) categorized as other. Median PCI was 16 (range: 2-39), 10 patients had PCI ≥20. Thirty-four patients (94%) had complete cytoreduction (CC 0-1), 19 patients recurred. CRS/HIPEC OS at 1, 3, and 5-years was 75%, 53%, and 32% respectively, with median OS of 37 months (CI 95%: 20-54). PFS in 32 patients with CC at 1, 3, and 5-years was 67%, 32% and 32%, respectively with median PFS of 18.9 months (CI 95%: 6.7-31). CONCLUSIONS:CRS/HIPEC is a promising treatment modality for patients with PS. Histological subtype may influence survival. A global prospective registry of patients to further assess the efficacy of CRS/HIPEC is needed.