<b>Leiomyosarcoma and General Statistics</b>

<b>The following abstracts of medical journal articles were compiled from Pubmed medical journal searches. Parts of the abstracts have been emphasized by the compiler by placing them in bold type. [Compiler's comments will appear in brackets [ ed. such as this].]</b>

<b>This will give a general, large Pubmed/Medline search for &&url</b>

J Surg Oncol 1998 Oct;69(2):94-8 
<b>Distant skin and soft tissue metastases from sarcomas. </b>
Rao UN, Hanan SH, Lotze MT, Karakousis CP. Department of Pathology, University of Pittsburgh Medical Center, Pennsylvania 15213, USA. 

,,, Five cases of sarcomas from different anatomical locations that had metastasized to skin and subcutaneous soft tissue were identified in three women and two men. ,,, The primary tumors had wide excisions, followed by either radiation or chemotherapy, or both. The histological types were ..., and leiomyosarcoma. Metastases occurred to the skin and soft tissue of the chest wall, leg, breast, and abdominal wall. The diagnosis was established by excision biopsies for three cases and by needle biopsy and fine-needle aspiration for two cases... Three patients died within 7 months of the diagnosis of soft tissue metastases that were always histologically high grade and never solitary. One patient is alive with lung metastasis discovered 17 months after excision of primary. Lung metastases occurred either simultaneously or within a short period after soft tissue metastases. ,,, Distant skin and soft tissue metastases from sarcomas are very rare and often occur as a terminal event. <b>[This points out the difficulties sometimes of deciding whether a tumor is a primary or a metastasis.  If it is a primary, complete excision might possibly effect a cure.  If it is a metastasis, there is no cure for stage IV LMS.  However, if it is a metastasis, the patient might still be able to be placed in surgical remission, for a prolonged survival, if the primary and any other mets can be found and excised.  Ed. ]</b>   
&&url PMID: 9808512  </b>


Chir Ital 2000 Jul-Aug;52(4):343-9 
<b>Clinical management of soft tissue sarcomas. </b>
Di Martino L, Dessena M, Demontis B, Grosso LP, Murenu G. Divisione di Chirurgia Sperimentale, Ospedale Oncologico A. Businco, Cagliari. 

<b>The prognosis of soft tissue sarcomas has dramatically improved over the past few decades thanks to the use of increasingly suitable multidisciplinary therapeutic approaches.</b> .... This type of tumour arises in a muscle compartment and then spreads proximally and distally within the compartment without involving adjacent structures, except in a relatively advanced phase, while as regards remote metastases the preferential diffusion route is via the bloodstream... Surgical management consists in extensive en bloc resection, followed by radiotherapy in the event of unclear margins and/or high grade tumour even when dealing with small sarcomas. The main indications for chemotherapy are locally advanced cases or cases with distant metastases. Thanks to these therapeutic approaches today, good results can be achieved, with 5-year survival rates of 80 and 67%, respectively, in stages I and II, and of 12 to 50% in the more advanced stages. Review, tutorial 
&&url PMID: 11190524 


Cancer 1999 Mar 1;85(5):1077-83
<b>Leiomyosarcoma of the inferior vena cava: prognosis and comparison with leiomyosarcoma of other anatomic sites. </b>
Hines OJ, Nelson S, Quinones-Baldrich WJ, Eilber FR Department of Surgery, University of California-Los Angeles School of Medicine, 90095, USA. 

.. Leiomyosarcoma of the inferior vena cava (IVC) is an uncommon tumor that many believe portends a poor prognosis compared with leiomyosarcoma with similar histology at other anatomic sites. ... From October 1978 to January 1997, 14 patients with leiomyosarcoma of the IVC were treated at the University of California-Los Angeles Medical Center. Wide resection was attempted in all patients. The characteristics of each patient were documented and compared with those of patients with leiomyosarcoma of the stomach (n = 13), small intestine (n = 18), retroperitoneum (n = 19), and uterus (n = 10) who were treated during the same time period. RESULTS: Age, gender, tumor size, tumor grade, and lymph node status did not impact survival of patients with leiomyosarcoma of the IVC. Patients with positive surgical margins fared significantly worse (P < 0.03) compared with those who underwent complete resection. Radiation therapy diminished local recurrence and may improve median survival (6 months [n = 2] vs. 51 months [n = 12]) in this patient population. Patients who received combined chemotherapy and radiation lived longer than those who did not (P < 0.05). The 5-year cumulative survival rate (Kaplan-Meier method) was 53% for patients with leiomyosarcoma of the IVC, 47% for those with leiomyosarcoma of the stomach, 43% for those with leiomyosarcoma of the small intestine, 56% for those with leiomyosarcoma of the retroperitoneum, and 65% for those with leiomyosarcoma of the uterus. CONCLUSIONS: Despite having a tumor that originates from the IVC, patients with this tumor type can enjoy reasonably long term survival. It appears that these patients benefit from radiation therapy to control local disease. Survival of these patients is no worse than of patients with leiomyosarcomatous lesions of other origin. Aggressive surgical management combined with adjuvant therapy offers the best treatment for patients with leiomyosarcoma of the IVC. [ed: Note: This is with respect to adjuvant treatment of LMS involving the major vein of the body, not necessarily adjuvant treatment of the other sites of occurrence.] 
&&url PMID: 10091791 


Surg 1998 Jan;64(1):53-60; discussion 60-1 
<b>Leiomyosarcoma: a 45-year review at Charity Hospital, New Orleans. </b>
Hill MA, Mera R, Levine EA Section of Surgical Oncology, Louisiana State University Medical Center, New Orleans 70112, USA. 

Approximately 2 to 9% of all soft tissue sarcomas are leiomyosarcomas (LMS). LMS arises nearly exclusively as tumors in adults, with peak incidence occurring in the fifth and sixth decades. The purpose of this study was to analyze disease-specific survival and define prognostic factors in patients with this disease who were treated and followed at a single institution. Fifty-eight cases of LMS were identified in the Tumor Registry of the Medical Center of Louisiana at New Orleans (charity Hospital) from 1950 to 1995. Charts were reviewed and tissue blocks reexamined to confirm the diagnosis. Follow-up information was available for 56 of 58 (96%) patients. Univariate and multivariate analyses were performed to analyze which factors predict outcome. The median survival time was 138 months. Univariate analysis identified age (> 48 years), location (retroperitoneal vs other sites), and extent of disease as prognostic factors. Multivariate analysis revealed that only age and the extent of disease at presentation are independent prognostic indicators. Race, sex, and adjuvant therapy were not significant prognostic factors. Surgical resection remains the therapeutic mainstay for patients with LMS. The value of other treatment modalities is largely limited to surgical failures. The data show that the age of the patient and the extent of disease at presentation are the best predictors of long-term survival. LMS has a good prognosis when complete resection of localized lesions can be achieved. 
&&url PMID: 9457038 


Ann Surg Oncol 1997 Apr-May;4(3):223-7 
<b>Leiomyosarcoma in childhood and adolescence.</b> 
Hwang ES, Gerald W, Wollner N, Meyers P, La Quaglia MP Department of Surgery, Memorial-Sloan Kettering Cancer Center, New York, New York 10021, USA. 

BACKGROUND: Few series of leiomyosarcoma in patients < 21 years of age have been reported. We reviewed our institutional experience with this neoplasm to learn disease characteristics, patterns of relapse, and outcome. METHODS: The records of 21 patients with leiomyosarcoma admitted to our institution were reviewed retrospectively; 18 of these were diagnosed after 1970. Overall survival was estimated using the Kaplan-Meier method. RESULTS: Ninety-five percent (20 of 21) were initially treated with a wide local excision that was complete with a negative microscopic margin in 10 (48%). There also was a strong correlation between grade and surgical margins. High-grade tumors were associated with a lower rate of complete resection. The majority underwent additional therapy. Radiation was used to treat both initial and recurrent disease in nine patients, with four of these undergoing brachytherapy. Thirteen patients were treated with adjuvant chemotherapy, most commonly doxorubicin (seven patients) and cisplatin (six patients). The median length of survival was 9.3 years, and there were nine disease-related deaths (43%). Of interest was the progressive decrease in survival with time. The 5-year overall survival rate was 79%; the 10-year rate was 49%. Three patients died of progressive disease > 10 years after initial diagnosis. CONCLUSIONS: We conclude that leiomyosarcomas arising in childhood and adolescence are associated with a good initial chance of survival that decreases progressively over time. Known prognostic factors from larger adult series are consistent with the present data, but they are not provable because of the small number of patients. In particular, the grade was correlated with surgical margins. 
&&url PMID: 9142383 
