Secondary cytoreduction in the management of recurrent uterine leiomyosarcoma.
OBJECTIVE
To identify effective treatment options for patients with recurrent uterine leiomyosarcoma (LMS).


METHODS
Patients with uterine LMS treated between 1976 and 1999 were identified. Charts were retrospectively reviewed and relevant clinical and pathologic data extracted. Survival curves were generated using the methods of Kaplan and Meier. Multivariate analysis was performed using the Cox proportional model.


RESULTS
Chart review identified 128 patients with recurrent uterine LMS. The median time to recurrence was 1.3 years. The median disease-specific survival from the time of first recurrence was 1.8 years. Multivariate analysis demonstrated secondary cytoreductive surgery, prolonged time to recurrence and localized recurrence were significantly and independently associated with improved disease-specific survival from time of first recurrence. Neither chemotherapy nor radiation therapy was associated with improvement in outcome in patients with recurrent uterine LMS.


CONCLUSIONS
These data suggest that secondary cytoreductive surgery is associated with prolonged survival in a select group of patients with recurrent uterine LMS. Patients presenting after a prolonged progression-free interval with an isolated site of recurrence amenable to complete resection are the best candidates for attempted surgical resection. These findings require confirmation from a larger and preferably prospectively gathered database.
Giuntoli
Robert L
RL
The Kelly Gynecologic Oncology Service, The Johns Hopkins Medical Institutions, 600 North Wolfe Street, Phipps #281, Baltimore, Maryland 21287, USA. rgiunto1@jhmi.edu <rgiunto1@jhmi.edu>
Garrett-Mayer
Elizabeth
E
Bristow
Robert E
RE
Gostout
Bobbie S
BS
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007890:Leiomyosarcoma / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D015996:Survival Rate; D014594:Uterine Neoplasms / Q000473:pathology / Q000601:surgery*