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Debate 40A - Should Primary Debulking Surgery be Performed for Metastatic Leiomyosarcoma?

Yes

from Section IV - Endometrial Cancer

Published online by Cambridge University Press:  20 July 2023

Dennis S. Chi
Affiliation:
Memorial Sloan-Kettering Cancer Center, New York
Nisha Lakhi
Affiliation:
Richmond University Medical Center, Staten Island
Nicoletta Colombo
Affiliation:
University of Milan-Bicocca
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Summary

Leiomyosarcomas (LMS) of the uterus are rare, aggressive malignancies with high rates of recurrence. Both uterine leiomyoma and LMS share common presenting symptoms; because of this, the diagnosis of uterine LMS is commonly made upon pathology evaluation after myomectomy or hysterectomy for suspected benign disease. Uterine LMS commonly expresses estrogen (ER) and progesterone (PR) receptors. However, the role of oophorectomy in premenopausal women with uterine LMS remains controversial. Based on the current literature, there appears to be no added benefit of removing bilateral ovaries following the diagnosis of early stage uterine LMS in premenopausal women. In addition, there remains minimal data demonstrating any increased risk of recurrence or tumor growth following ovarian preservation in this patient population. If the ovaries are preserved, close long-term follow-up is important.

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Publisher: Cambridge University Press
Print publication year: 2023

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References

Hensley, ML, et al. Adjuvant gemcitabine plus docetaxel for completely resected stages I–IV high-grade uterine leiomyosarcoma: results of a prospective study. Gynecol Oncol 2009;112:563.CrossRefGoogle ScholarPubMed
Dinh, TA, et al. The treatment of uterine leiomyosarcoma. Results from a 10-year experience (1990–1999) at the Massachusetts General Hospital. Gynecol Oncol 2004;92:648652.Google ScholarPubMed
Leitao, MM Jr, et al. Surgical cytoreduction in patients with metastatic uterine leiomyosarcoma at the time of initial diagnosis. Gynecol Oncol 2012;125(2):409413.CrossRefGoogle ScholarPubMed
Friedman, CF, et al. Options for adjuvant therapy for uterine leiomyosarcoma. Curr Treat Options Oncol 2018;19(2):7.CrossRefGoogle ScholarPubMed
Reed, NS, et al. Phase III randomized study to evaluate the role of adjuvant pelvic radiotherapy in the treatment of uterine sarcomas stage I and II: a European Organisation for Research and Treatment of Cancer Gynaecological Cancer Group Study (protocol 55874). Eur J Cancer 2008;44:808818.CrossRefGoogle Scholar
Burt, BM, et al. Repeated and aggressive pulmonary resections for leiomyosarcoma metastases extends survival. Ann Thorac Surg 2011;92:1207.CrossRefGoogle ScholarPubMed

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