title: Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the management of recurrent high-grade uterine sarcoma with peritoneal dissemination.
abstract: OBJECTIVE
  Peritoneal sarcomatosis from primary uterine sarcoma (US) is a rare condition. Conventional therapeutic modalities have failed to improve survival and outcomes among patients with high-grade US with extrapelvic spread. Cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) has shown improved outcomes for peritoneal carcinomatosis from other epithelial primaries with similar clinical presentation. We report our experience applying this treatment in 3 patients with recurrent high-grade US with peritoneal dissemination.
  
  
  METHODS
  This retrospective review of a prospective database of 378 patients with peritoneal dissemination of cancer treated with CRS/HIPEC identified 3 patients with recurrent high-grade US. Follow-up for disease progression was carried out by physical examination and computed tomography scan of the chest, abdomen, and pelvis.
  
  
  RESULTS
  Two leiomyosarcomas and 1 adenosarcoma with sarcomatous overgrowth were identified. Two of the 3 had failed standard treatment with surgery and systemic chemotherapy before CRS/HIPEC was performed. Follow-up ranged from 34 to 140 months. All 3 patients are alive, 2 with no evidence of disease (NED), and 1 alive with disease. Adramycin/cisplatin was used for HIPEC in 1 case (140 months with NED), whereas melphalan was used in the other 2 cases (53 months alive with disease, 34 months with NED). Two patients underwent 1 CRS/HIPEC, whereas 1 required 3 CRS/HIPEC due to disease recurrence.
  
  
  CONCLUSIONS
  CRS/HIPEC shows promise as a treatment modality for the management of selected patients with recurrent high-grade US with peritoneal dissemination. Further studies are warranted.
authors.affiliation: Institute for Cancer Care, Mercy Medical Center, Baltimore, MD.
authors.forename: William A
authors.initials: WA
authors.lastname: Jimenez
authors.affiliation: Institute for Cancer Care, Mercy Medical Center, Baltimore, MD. Electronic address: asardi@mdmercy.com.
authors.forename: Armando
authors.initials: A
authors.lastname: Sardi
authors.affiliation: Institute for Cancer Care, Mercy Medical Center, Baltimore, MD.
authors.forename: Carol
authors.initials: C
authors.lastname: Nieroda
authors.affiliation: Institute for Cancer Care, Mercy Medical Center, Baltimore, MD.
authors.forename: Vadim
authors.initials: V
authors.lastname: Gushchin
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000628:therapy*; D010534:Peritoneal Neoplasms / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D011379:Prognosis; D012189:Retrospective Studies; D012509:Sarcoma / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*
keywords: cytoreductive surgery; hyperthermic intraperitoneal chemotherapy; peritoneal sarcomatosis; uterine sarcoma