Paulina Cybulska1, Vasileios Sioulas1, Theofano Orfanelli1, Oliver Zivanovic2, Jennifer J Mueller2, Vance A Broach2, Kara C Long Roche2, Yukio Sonoda2, Martee L Hensley3, Roisin E O'Cearbhaill3, Dennis S Chi2, Kaled M Alektiar4, Nadeem R Abu-Rustum2, Mario M Leitao5. 1. Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA. 2. Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Weill Cornell Medical College, New York, NY 10065, USA. 3. Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Weill Cornell Medical College, New York, NY 10065, USA. 4. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Weill Cornell Medical College, New York, NY 10065, USA. 5. Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; Weill Cornell Medical College, New York, NY 10065, USA. Electronic address: leitaom@mskcc.org.
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.
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.
Authors: Winette T A van der Graaf; Jean-Yves Blay; Sant P Chawla; Dong-Wan Kim; Binh Bui-Nguyen; Paolo G Casali; Patrick Schöffski; Massimo Aglietta; Arthur P Staddon; Yasuo Beppu; Axel Le Cesne; Hans Gelderblom; Ian R Judson; Nobuhito Araki; Monia Ouali; Sandrine Marreaud; Rachel Hodge; Mohammed R Dewji; Corneel Coens; George D Demetri; Christopher D Fletcher; Angelo Paolo Dei Tos; Peter Hohenberger Journal: Lancet Date: 2012-05-16 Impact factor: 79.321
Authors: Oliver Zivanovic; Lindsay M Jacks; Alexia Iasonos; Mario M Leitao; Robert A Soslow; Emanuela Veras; Dennis S Chi; Nadeem R Abu-Rustum; Richard R Barakat; Murray F Brennan; Martee L Hensley Journal: Cancer Date: 2011-07-12 Impact factor: 6.860
Authors: R L Jones; J McCall; A Adam; D O'Donnell; S Ashley; O Al-Muderis; K Thway; C Fisher; I R Judson Journal: Eur J Surg Oncol Date: 2010-01-08 Impact factor: 4.424
Authors: Oliver Zivanovic; Mario M Leitao; Alexia Iasonos; Lindsay M Jacks; Qin Zhou; Nadeem R Abu-Rustum; Robert A Soslow; Margrit M Juretzka; Dennis S Chi; Richard R Barakat; Murray F Brennan; Martee L Hensley Journal: J Clin Oncol Date: 2009-03-02 Impact factor: 44.544
Authors: David B Chapel; Aarti Sharma; Ricardo R Lastra; Livia Maccio; Emma Bragantini; Gian Franco Zannoni; Suzanne George; Bradley J Quade; Carlos Parra-Herran; Marisa R Nucci Journal: Mod Pathol Date: 2022-02-04 Impact factor: 7.842