Aust N Z J Obstet Gynaecol 1999 May;39(2):246-8

<b>Uterine leiomyosarcoma--a Singapore experience</b>.
Soh LT, Chew SH, Ang L Kandang Kerbau Hospital, Singapore.
Uterine leiomyosarcoma is an aggressive tumour. In our retrospective series of 27 patients, there were 25 with nonmyxoid high-grade leiomyosarcoma of the uterus. The stage distribution was Stage 1, 16; Stage 3, 5 and Stage 4, 4. In the patients with Stage 1 disease, 3 of the 8 patients who received adjuvant chemotherapy subsequently developed recurrent disease. In contrast, 6 of the 8 patients who did not receive adjuvant chemotherapy subsequently developed recurrent disease;
2 of the patients in the latter group also received adjuvant radiotherapy. Six of the 9 women with recurrences were distant 'failures' alone, 2 were both distant and pelvic 'failures' and 1 was pelvic 'failure' alone. All the patients with advanced-stage disease eventually succumbed to the disease despite the therapies given. <b>This study is small and retrospective but it suggests that there might be a role for adjuvant chemotherapy in the management of the early stage of this disease</b>. 
&&url PMID: 10755790 


Aust N Z J Obstet Gynaecol 1999 Feb;39(1):93-8

<b>Management of uterine leiomyosarcoma in Australia</b>.

Gard GB, Mulvany NJ, Quinn MA Department of Obstetrics and Gynaecology, University of Melbourne.
Uterine leiomyosarcoma is an uncommon malignancy for which the management varies widely between individual gynaecologists and gynaecological oncology units. We have performed a retrospective review of patients treated at both the RoyalWomen's Hospital in Melbourne (1970-1997) and King George V Hospital in Sydney (1987-1993). In addition we have performed a survey of Certified Gynaecological Oncologists (CGO's) to assess the current management of uterine leiomyosarcomas in Australia. The results show varied management practices exist in Australia, many of which are not supported by evidence in the current literature.

Oophorectomy in the premenopausal patient appears unnecessary unless the ovaries are macroscopically involved. The role of pelvic lymphadenectomy is debatable. This practice was recommended by many CGO's, yet these nodes are rarely positive unless obvious extrauterine disease is present. <b>Adjuvant chemotherapy appears not to have a role at present unless in a trial setting. Adjuvant radiotherapy does appear to have a potential palliative role as it prevents locoregional relapse, although survival is not prolonged. Until suitable phase 3 trials are available, gynaecological oncology units should be meticulous in prospectively recording the clinical course of their patients and critically analyzing their current management strategies</b>. Publication Types: Review 
&&url PMID: 10099759


Am 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 Univ Medical Center,New Orleans 70112,US
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. <b>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 wereperformed 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 thetherapeutic 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 predictorsof long-term survival. LMS has a good prognosis when complete resection of localized lesions can be achieved.</b> 
&&url PMID: 9457038 

J Gynecol Obstet Biol Reprod (Paris) 1997;26(3):256-62

<b>[Uterine leiomyosarcoma. Nine case reports, review of the literature].[Article in French]</b>

Razafintsalama T, Leveque J, Le Gall F, Paumier V, Pangui E, Kerisit J, Grall JY 

Service de Gynecologie B, Hopital Sud, Rennes.

OBJECT OF THE STUDY: To evaluate management and outcome of the treatment of uterine leiomyosarcoma. PATIENTS AND METHODS: Retrospective study of a series of 9 patients treated for uterine leiomyosarcoma in this hospital from 1982 to 1994. RESULTS: The condition is rarely suspected preoperatively, diagnosis is usually made on histological examination of the operative specimen. <b>The outcome is related to the mitotic activity of the tumour and to the infiltration of nearly structures. Surgery is the only effective treatment, chemotherapy is ineffective, adjuvant radiotherapy improves local control of the tumour but has no incidence on survival. CONCLUSION: In the absence of an effective adjuvant treatment uterine leiomyosarcoma bears a poor prognosis with the only exception of small non infiltrating tumours with a low mitotic activity.</b> 
&&url PMID: 9265046


Eur J Gynaecol Oncol 1997;18(3):192-5

<b>Uterine sarcoma: a clinicopathological study of 93 cases.</b>

Gonzalez-Bosquet E, Martinez-Palones JM, Gonzalez-Bosquet J, Garcia Jimenez A, Xercavins J

Department of Gynecologic Surgery/Gynecologic Oncology, Hospital Universitario Materno-Infantil Vall d'Hebron, Barcelona, Spain.

OBJECTIVE: To evaluate the clinical outcome of patients suffering from primary uterine sarcoma diagnosed and treated in our Hospital. SETTING: Department of Gynecologic Surgery/Gynecologic Oncology, Hospital Universitario Materno-Infantil Vall d'Hebron de Barcelona, Barcelona, Spain. SUBJECTS AND METHODS: A retrospective review from 1967 to 1995 of clinical and pathological characteristics of 93 patients with primary uterine sarcoma was done. Patients were staged using the 1988 FIGO histological classification for uterine cancer. Clinical features, type of surgery, adjuvant therapy, recurrences, distant metastasis, and survival were recorded. RESULTS: Our study included three main histologic types: <b>44 patients with leiomyosarcoma</b>, 26 patients with endometrial stromal sarcoma, and 18 patients with mixed Mullerian sarcomas. The mean age for all patients was 54.8 years, and the most common symptom was vaginal bleeding. Other clinicopathological features were examined. <b>Although surgery was the most frequent treatment, adjuvant therapies have been analyzed and discussed. The overall three-year survival rate was 67.9% and the overall five-year survival rate was 64.5%. We found statistical differences (p < 0.001) between the stage I survival rate and other stage survival rates. CONCLUSIONS: Uterine sarcoma is an uncommon neoplasia diagnosed in the 6th decade of life. Leiomyosarcoma is the most frequent histologic type (47.3%). Stage I uterine sarcoma has a better prognosis than other stages.</b> 
&&url PMID: 9174834


J Surg Oncol 1997 Jan;64(1):55-62

<b>Uterine sarcoma in the south of Israel: study of 36 cases.</b>

Piura B, Rabinovich A, Yanai-Inbar I, Cohen Y, Glezerman M

Department of Obstetrics and Gynecology, Soroka Medical Center, Beer-Sheva, Israel.

BACKGROUND: Uterine sarcomas are rare, characterised by rapid clinical progression and poor prognosis, and their management has been a challenge. The purpose of this study was to investigate the clinical and histologic findings, treatment, and outcome of patients with uterine sarcoma in the south of Israel. METHODS: Data from the files of 36 patients with uterine sarcoma who were managed at the Soroka Medical Center between January 1961 and December 1994 were evaluated. RESULTS: <b>The 5-year survival rate was</b> 32% overall; 63% for 9 patients with endometrial stromal sarcoma (ESS). 30% for 14 patients with mixed mesodermal sarcoma (MMS) and <b>18% for 13 patients with leiomyosarcoma (LMS): 41% for 22 patients with Stage I and 19% for 14 patients with Stages II, III, and IV. Only the difference in the 5-year survival rate between ESS and LMS was statistically significant (P < 0.05).</b> Eleven patients (30.6%) were treated with surgery alone, 4 (11.1%) with surgery followed by pelvic radiotherapy, 11 (30.6%) with surgery followed by chemotherapy, 8 (22.2%) with surgery followed by pelvic radiotherapy and chemotherapy, one (2.8%) with chemotherapy alone, and one (2.8%) had no treatment. <b>CONCLUSIONS: Uterine sarcomas are aggressive tumorswith a poor prognosis. The treatment is surgery generally followed by adjuvant pelvic radiotherapy and/or systemic chemotherapy.</b> 
&&url PMID: 9040802


Bull Cancer 1997 Jun;84(6):625-9

<b>[Uterine sarcoma treated by surgery and postoperative radiation therapy. Patterns of relapse, prognostic factors and role of radiation therapy]. [Article in French]</b>

Coquard R, Romestaing P, Ardiet JM, Mornex F, Sentenac I, Gerard JP Service de radiotherapie-oncologie, Centre Hospitalier Lyon Sud, Pierre-Benite, France.

The objective was to evaluate the results of a combination of surgery and postoperative radiotherapy in patients with uterine sarcoma, to describe the patterns of relapse and to define prognostic factors. From 1980 to 1993, 29 patients (median age: 56 years) presenting with uterine sarcoma have been treated with <b>surgery and postoperative irradiation.</b> The histology was: <b>leiomyosarcoma: 11</b>; carcinosarcoma: 12; stromal sarcoma: 6. The distribution by stage was: pT1: 18; pT2: 5; pT3: 3; pT4: 3; pNO: 27; pN1: 2. Gross residual disease was present in 4 patients. External beam irradiation was performed in all the cases and brachytherapy in 19. Chemotherapy was given in 3 patients. <b>The overall survival rate was 66% at 2 years and 57% at 5 years with a disease free survival of 54% at 2 years and 50% at 5 years.</b> Seven patients relapsed locally and 8 developed metastases. <b>One patient died of ileitis.</b> In a multivariate analysis, the disease free survival was strongly influenced by the menopausal status. The survival in this study is higher than that described in series of patients treated with surgery alone. This study confirms the worse prognosis of uterine sarcoma in postmenopausal women. [Note: there is no mention of grading of tumors, which has a major effect on survival...one needs the entire paper to evaluate.] Publication Types: Review, multicase 
&&url PMID: 9295866


J Surg Oncol 1996 Nov;63(3):145-7

<b>Malignant uterine smooth muscle tumors: role of etoposide, cisplatin, and doxorubicin (EPA) chemotherapy.</b>

Resnik E, Chambers SK, Carcangiu ML, Kohorn EI, Schwartz PE, Chambers IT Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, Connecticut, USA.

<b>BACKGROUND: Nearly 80% of patients with malignant uterine smooth muscle tumor will suffer local relapse and/or distant metastases after initial surgical resection. There is no convincing evidence that the addition of pelvic radiation improves the outcome. However, adjuvant chemotherapy might be an appropriate therapeutic modality.</b> METHODS: Between 1986 and 1991, <b>13 consecutive patients with malignant uterine smooth muscle tumors</b> were treated at Yale-New Haven Hospital with a combination chemotherapy containing etoposide 100 mg/M2 on days 1 and 2, cisplatin 50 mg/M2 on day 1, and doxorubicin 50 mg/M2 on day 1, repeated every 28 days. <b>Six patients had Stage I disease, one patient had Stage III disease, and six patients had Stage IV disease.</b> The number of cycles ranged from 2 to 9. RESULTS: The median follow-up was 30 months (range 4-81). The mean overall survival for the group was 43.1 6.7 months, with the progression-free interval of 25.5 8.0 months. <b>Of the seven patients with evaluable disease, one patient had complete response and one had partial response (total response rate of 28.6%). Of the six patients treated adjuvantly, three recurred at 9, 33, and 59 months (recurrence rate of 50%). CONCLUSIONS: Weconclude that this combination has only modest activity against malignant uterine smooth muscle tumors at the schedule and doses tested.</b> 
&&url PMID: 8944057


Eur J Gynaecol Oncol 1993;14 Suppl:105-13

<b>Different types and different prognosis-study of 310 uterine sarcomas.</b>

Nickie-Psikuta M, Gawrychowski K Department of Gynaecological Oncology, Maria Slodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland.

<b>Three hundred and ten cases of uterine sarcomas, among them, according to pathology: LMS (Leiomyosarcoma)--117</b>, MMS (Mixed mesodermal sarcoma)--62, ESS (Endometrial stromal sarcoma)--56, CS (Carcinosarcoma)--27, RBMS (Rhabdomyosarcoma)--18 and other sarcomas--30, were retrospectively evaluated at the Maria Sklodowska-Curie Memorial Cancer Center between 1950 and 1985. These mesodermal tumors were divided into uterine corpus sarcomas (295) and the rarely occurring uterine cervix sarcomas. As the main modality of treatment 307 patients underwent surgery. <b>Almost all patients received adjuvant radiotherapy but 51 cases of LMS. Overall 5-year survival was 34.5% and in particular subgroups the survivals were as follows: the best, 52% in LMS;</b> lower, 30% in ESS; poor survival about 20% in CS and MMS. In spite of low curability in the majority of subgroups except LMS, the cases of CS with primary site in uterine cervix distinguished itself with better results. <b>No significant survival advantage was found for surgery plus radiotherapy in LMS with low grade mitotic activity, (10 mitoses/10 HPF) compared with surgery alone (63% and 54%). These cases seem to have better prognosis in LMS with high grade mitotic activity (10 mitoses/10 HPF) and do not require adjuvant radiotherapy.</b> 
&&url PMID: 8200360

Cancer 1993 Feb 15;71(4 Suppl):1702-9

<b>Prognostic factors in early-stage uterine sarcoma. A Gynecologic Oncology Group study.</b>

Major FJ, Blessing JA, Silverberg SG, Morrow CP, Creasman WT, Currie JL, Yordan E, Brady MF. University of Colorado School of Medicine, Denver.
BACKGROUND. A clinicopathologic evaluation of clinical Stage I and II uterine sarcoma was done by the Gynecologic Oncology Group from 1979-1988. METHODS. After all eligibility criteria were met, 453 cases were evaluable and analyzed for prognostic factors. RESULTS. Of the 301 mixed mesodermal tumors (MMT), 167 were homologous (HO), and 134 were heterologous (HE). <b>Fifty-nine tumors were leiomyosarcomas (LM)</b>. The remaining 93 sarcomas were predominantly stromal cell and adenosarcomas. For this study, only the MMT or LM tumors were analyzed. The recurrence rate for all MMT was 53% (HO, 44%; HE, 63%). <b>The recurrence rate for LM was 71%. The site of the first recurrence included the pelvis in 21% of MMT and 14% in LM.</b> Factors significantly related to progression-free interval (PFI) by univariate analysis among MMT were adnexal spread, lymph node metastases, tumor size, lymphatic-vascular space involvement, histologic grade, cell type, age, peritoneal cytologic findings, and depth of uterine tumor site of invasion. The prognostic factors based on multivariate analysis were adnexal spread, lymph node metastases, histologic cell type (HO versus HE), and grade of sarcoma. <b>For LM, the mitotic index was the only factor significantly related to PFI.</b> 
&&url PMID: 8381710


Eur J Gynaecol Oncol 1990;11(3):225-31

<b>Treatment of patients with sarcoma of the uterus.</b>

Bokhman JV, Yakovleva IA, Urmanchejeva AF. Petrov Research Institute of Oncology, USSR Ministry of Health, Leningard.

In the present series of 156 patients with sarcomas of the uterus the therapeutic modalities employed were evaluated. <b>The 5-year survival rate of 51.3% was obtained for this series including 41.2% for leiomyosarcomas</b>, 57.1% for endometrial stromal sarcomas, 50.0% for mixed mesodermal tumors and 40.0% for carcinosarcomas. The prognostic significance of the extent of disease, histological type and the age of patients is emphasised. <b>Clinical features of uterine sarcomas specific for different histological types were shown: leiomyosarcomas were characterized by a rapid tumor growth</b> while uterine bleeding in the background of neuroendocrine disturbances similar to those observed in endometrial carcinomas were related to endometrial stromal sarcomas and mixed mesodermal tumors. In respect to early diagnosis of sarcomas an ultrasonic pelvic examination and studies of aspirate specimens taken from the uterine cavity are recommended to be performed for the groups at high risk. An individual treatment policy was developed for each sarcoma patient depending on the histological type, the stage of disease and general condition of the patient. <b>Surgical approach varied ranging from a total hysterectomy and adnexectomy, done for leiomyosarcomas</b>, to an extended hysterectomy and pelvic lymphadenectomy for mixed mesodermal tumors and endometrial stromal sarcomas. <b>Postoperative distant and/or endovaginal radiation are indicated for all histological types of sarcomas excepting leiomyosarcomas. Application of adjuvant chemotherapy with carminomycin or adriamycin improves the results of treatment.</b> 
&&url PMID: 2209643

Vopr Onkol 1989;35(10):1245-51

<b>[Treatment of patients with sarcoma of the uterus]. [Article in Russian]</b>

Bokhman IV, Urmancheeva AF.
<b>The choice of treatment for uterine sarcoma should be determined by histological pattern and stage of tumor as well as by the patient's general condition. Operation should be withheld unless it is life-saving. The extent of surgeryshould vary from extirpation of the uterus with the appendages (leiomyosarcoma)</b> to extended extirpation with pelvic lymphadenectomy for mixed mesodermal tumor, carcinosarcoma and endometrial stromal sarcoma. <b>In the three latter cases, surgery should be followed by distant and/or endovaginal irradiation. Administration of such antitumor antibiotics as carminomycin and adriamycin assures a significantly longer survival in cases of recurrent and disseminated uterine sarcoma.</b> 
&&url PMID: 2596071 

J Clin Oncol 1985 Sep;3(9):1240-5

<b>A randomized clinical trial of adjuvant adriamycin in uterine sarcomas: a Gynecologic Oncology Group Study.</b>

Omura GA, Blessing JA, Major F, Lifshitz S, Ehrlich CE, Mangan C, Beecham J, Park R, Silverberg S


<b>After hysterectomy, 156 evaluable patients with stage I (limited to the corpus) or stage II (limited to the corpus and cervix) uterine sarcomas were randomly assigned to adjuvant chemotherapy with Adriamycin (Adria Laboratories, Columbus, Ohio) for six months or to no further treatment. Pelvic irradiation (external or intracavitary) was optional before randomization. Of 75 patients receiving Adriamycin, 31 have suffered recurrences compared with 43 of 81 receiving no adjuvant chemotherapy. This difference is not statistically significant. Moreover, there is no difference in progression-free interval or survival. The optional radiotherapy did not influence the outcome although there was a suggestion that vaginal recurrence was decreased by pelvic radiotherapy. The recurrence rates in specific cell types (leiomyosarcoma, homologous mixed mesodermal sarcoma, or heterologous mixed mesodermal sarcoma) were not significantly different although the pattern of recurrence differed, with pulmonary metastases being more common in leiomyosarcoma</b> and extrapulmonary recurrence being more common in mixed mesodermal sarcoma. The outcome with respect to chemotherapy was not altered even after adjusting for maldistribution of cases. <b>Thus, we could not show a benefit for this dose schedule of Adriamycin as adjuvant treatment for uterine sarcomas.Publication Types: Clinical trial Randomized controlled trial</b> 
&&url PMID: 3897471

Am J Obstet Gynecol 1985 Apr 15;151(8):1016-22

<b>Uterine sarcoma: analysis of prognostic variables in 71 cases.</b>

Wheelock JB, Krebs HB, Schneider V, Goplerud DR

The histories of 94 patients with a diagnosis of uterine sarcoma, treated from 1962 to 1982, at the Medical College of Virginia Hospital were reviewed. Histologic features were studied by one of the authors (V.S.), and cases that did not meet strict pathologic criteria were rejected. The 71 patients with uterine sarcoma accepted for this study had a survival rate of 22.5% from 1 to 11 years. <b>Survival rates were similar for leiomyosarcoma, mixed mesodermal tumor, and endometrial stromal sarcoma. Clinical staging had some predictive value, since 45 patients with Stage I disease had a 27% survival rate, and 26 patients with Stages II, III, and IV disease had only a 12% survival rate (p less than 0.05). The type of treatment had no demonstrable effect on final outcome but did influence the recurrence patterns. Chemotherapy (used in 25 patients) was neither of benefit when used as adjuvant therapy nor effective inprolonging survival in patients with recurrence (mean survival, 5.4 months).</b> 
&&url PMID: 2984936

Pathol Res Pract 1980 Oct;169(2):120-6

<b>[Clinical aspects of uterine sarcomas (author's transl)]. [Article in German]</b>

Stegner HE
Uterine sarcomas constitute 1% to 3% of all uterine cancers. There are three main histological varieties: endometrial stromal sarcoma, <b>leiomyosarcoma</b>, and mixed mesodermal (Mullerian) sarcoma. The tumors are characterized by local aggressiveness and early dissemination. <b>According to the literature, 5 year survival rates range from 3 to 75% (!).</b> This wide range reflects great prognostic differences in the various histologic types. On the other hand it may be due to discrepancies in histopathological evaluation. <b>Radical surgery is the most effective therapy. In early stages it leads to 5 year survival rates of up to 88%. Adjuvant irradiation may increase the control of disease in the pelvis but has proven to be of little influence on the final outcome.</b> The histologic variants show great differences in radiosensitivity. In endometrial stromal sarcomas adjuvant radiation therapy apparently can improve the treatment results. By contrast mixed mesodermal sarcomas are highly radioresistant. There is poor knowledge on the effectiveness of cytotoxic agents on uterine sarcomas. <b>Objective remission of distant metastasis has been observed following treatment with cytotoxic antibiotics (Adriamycin)</b>. 
&&url PMID: 7443570

compiled by doctordee

