Diagnosis and treatment in a case of uterine leiomyosarcoma - case report and review of the literature
DOI:
https://doi.org/10.12775/JEHS.2023.46.01.021Keywords
uterine leiomyosarcoma, uterine sarcoma, hysterectomy, gynecologic oncologyAbstract
Introduction: Uterine leiomyosarcoma accounts for approximately 3%–7% of all uterine cancers and it is the most common subtype of uterine sarcoma. They are associated with high potential to both local recurrence and distant metastases, and they contribute to a significant proportion of uterine cancer deaths. Tumor stage is the single most important prognostic factor for uterine sarcomas. Presenting symptoms may be vague and mimic other benign uterine conditions.
The aim of the study: This study aims to describe a case of uterine leiomyosarcoma and summarize current knowledge about classification, diagnostics and treatment.
Materials and methods: The research method was a case study. This review was based on available data collected in the PubMed database and Google Scholar web search engine, using the key words: uterine leiomyosarcoma, uterine sarcoma, hysterectomy, gynecologic oncology.
Conclusion: Surgery is considered the mainstay of treatment for sarcomas limited to the uterus. In patients with carcinosarcomas postoperative radiotherapy increases the local control. High rate of distant metastases suggests potential role of systemic therapy. However, the benefits of postoperative chemotherapy and endocrine therapy in high-risk patients are of no proven value in the adjuvant setting. These methods, in addition to palliative radiotherapy and surgery are used in recurrent and advanced disease.
Keywords: uterine leiomyosarcoma, uterine sarcoma, hysterectomy, gynecologic oncology
References
D'Angelo E, Prat J. Uterine sarcomas: a review. Gynecol Oncol. 2010 Jan;116(1):131-9. doi: 10.1016/j.ygyno.2009.09.023. Epub 2009 Oct 23. PMID: 19853898.
Roberts ME, Aynardi JT, Chu CS. Uterine leiomyosarcoma: A review of the literature and update on management options. Gynecol Oncol. 2018 Dec;151(3):562-572. doi: 10.1016/j.ygyno.2018.09.010. Epub 2018 Sep 21. PMID: 30244960.
Giuntoli RL 2nd, Metzinger DS, DiMarco CS, Cha SS, Sloan JA, Keeney GL, Gostout BS. Retrospective review of 208 patients with leiomyosarcoma of the uterus: prognostic indicators, surgical management, and adjuvant therapy. Gynecol Oncol. 2003 Jun;89(3):460-9. doi: 10.1016/s0090-8258(03)00137-9. PMID: 12798712.
Gockley AA, Rauh-Hain JA, del Carmen MG. Uterine leiomyosarcoma: a review article. Int J Gynecol Cancer. 2014 Nov;24(9):1538-42. doi: 10.1097/IGC.0000000000000290. PMID: 25304676.
Abel MK, Liao CI, Chan C, Lee D, Rohatgi A, Darcy KM, Tian C, Mann AK, Maxwell GL, Kapp DS, Chan JK. Racial disparities in high-risk uterine cancer histologic subtypes: A United States Cancer Statistics study. Gynecol Oncol. 2021 May;161(2):470-476. doi: 10.1016/j.ygyno.2021.02.037. Epub 2021 Mar 13. PMID: 33722415.
Gillett D. Leiomyosarcoma of the uterus in a woman taking adjuvant tamoxifen therapy. Med J Aust. 1995 Aug 7;163(3):160-1. doi: 10.5694/j.1326-5377.1995.tb127978.x. PMID: 7643773.
R.J. Kurman, International Agency for Research on Cancer, World Health Organization, WHO Classification of Tumours of Female Reproductive Organs, 4th ed. International Agency for Research on Cancer, Lyon, 2014 (307 pp.)
Rose PG, Piver MS, Tsukada Y, Lau T. Patterns of metastasis in uterine sarcoma. An autopsy study. Cancer. 1989 Mar 1;63(5):935-8. doi: 10.1002/1097-0142(19890301)63:5<935::aid-cncr2820630525>3.0.co;2-9. PMID: 2914299.
Major, F. J., Blessing, J. A., Silverberg, S. G., Morrow, C. P., Creasman, W. T., Currie, J. L., … Brady, M. F. (1993). Prognostic factors in early-stage uterine sarcoma: A gynecologic oncology group study. Cancer, 71(S4), 1702–1709. doi:10.1002/cncr.2820710440
FIGO Committee on Gynecologic Oncology. Revised FIGO staging for carcinoma of the vulva, cervix, and endometrium. Int. J. Gynecol. Obstet. 2009; 105: 103–104.
Cui RR, Wright JD, Hou JY. Uterine leiomyosarcoma: a review of recent advances in molecular biology, clinical management and outcome. BJOG. 2017 Jun;124(7):1028-1037. doi: 10.1111/1471-0528.14579. Epub 2017 Apr 1. PMID: 28128524.
Lawlor, H., Ward, A., Maclean, A., Lane, S., Adishesh, M., Taylor, S., … Hapangama, D. K. (2020). Developing a Preoperative Algorithm for the Diagnosis of Uterine Leiomyosarcoma. Diagnostics, 10(10), 735. doi:10.3390/diagnostics10100735
Mbatani N, Olawaiye AB, Prat J. Uterine sarcomas. Int J Gynaecol Obstet. 2018 Oct;143 Suppl 2:51-58. doi: 10.1002/ijgo.12613. PMID: 30306577.
Sun S, Bonaffini PA, Nougaret S, Fournier L, Dohan A, Chong J, Smith J, Addley H, Reinhold C. How to differentiate uterine leiomyosarcoma from leiomyoma with imaging. Diagn Interv Imaging. 2019 Oct;100(10):619-634. doi: 10.1016/j.diii.2019.07.007. Epub 2019 Aug 16. PMID: 31427216.
Amant F, Coosemans A, Debiec-Rychter M, Timmerman D, Vergote I. Clinical management of uterine sarcomas. Lancet Oncol. 2009 Dec;10(12):1188-98. doi: 10.1016/S1470-2045(09)70226-8. PMID: 19959075.
Kornafel J., Bidziñski M., Gawrychowski K. Ginekologia Onkologiczna 297-298
Cornfeld D, Israel G, Martel M, Weinreb J, Schwartz P, McCarthy S. MRI appearance of mesenchymal tumors of the uterus. Eur J Radiol. 2010 Apr;74(1):241-9. doi: 10.1016/j.ejrad.2009.03.005. Epub 2009 Apr 5. PMID: 19349135.
DeMulder D, Ascher SM. Uterine Leiomyosarcoma: Can MRI Differentiate Leiomyosarcoma From Benign Leiomyoma Before Treatment? AJR Am J Roentgenol. 2018 Dec;211(6):1405-1415. doi: 10.2214/AJR.17.19234. Epub 2018 Oct 24. PMID: 30354268.
Kitajima K, Murakami K, Kaji Y, Sugimura K. Spectrum of FDG PET/CT findings of uterine tumors. AJR Am J Roentgenol. 2010 Sep;195(3):737-43. doi: 10.2214/AJR.09.4074. PMID: 20729454.
Cher S, Lay Ergun E. Positron emission tomographic-computed tomographic imaging of a uterine sarcoma. Clin Nucl Med. 2003 May;28(5):443-4. doi: 10.1097/01.RLU.0000063701.90033.7D. PMID: 12702956.
Giuntoli RL 2nd, Metzinger DS, DiMarco CS, Cha SS, Sloan JA, Keeney GL, Gostout BS. Retrospective review of 208 patients with leiomyosarcoma of the uterus: prognostic indicators, surgical management, and adjuvant therapy. Gynecol Oncol. 2003 Jun;89(3):460-9. doi: 10.1016/s0090-8258(03)00137-9. PMID: 12798712.
George S, Serrano C, Hensley ML, Ray-Coquard I. Soft Tissue and Uterine Leiomyosarcoma. J Clin Oncol. 2018 Jan 10;36(2):144-150. doi: 10.1200/JCO.2017.75.9845. Epub 2017 Dec 8. PMID: 29220301; PMCID: PMC5759317.
Ricci S, Stone RL, Fader AN. Uterine leiomyosarcoma: Epidemiology, contemporary treatment strategies and the impact of uterine morcellation. Gynecol Oncol. 2017 Apr;145(1):208-216. doi: 10.1016/j.ygyno.2017.02.019. Epub 2017 Feb 13. PMID: 28209496.
Juhasz-Böss I, Gabriel L, Bohle RM, Horn LC, Solomayer EF, Breitbach GP. Uterine Leiomyosarcoma. Oncol Res Treat. 2018;41(11):680-686. doi: 10.1159/000494299. Epub 2018 Oct 16. PMID: 30321869.
Chantharasamee J, Wong K, Potivongsajarn P, Qorbani A, Motamed N, Brackert S, Cohen J, Chmielowski B, Kalbasi A, Rao J, Nelson S, Singh A. Retrospective analysis of adjuvant treatment for localized, operable uterine leiomyosarcoma. Cancer Med. 2022 Aug;11(15):2906-2912. doi: 10.1002/cam4.4665. Epub 2022 Mar 20. PMID: 35307963; PMCID: PMC9359871.
Gadducci A, Landoni F, Sartori E, Zola P, Maggino T, Lissoni A, Bazzurini L, Arisio R, Romagnolo C, Cristofani R. Uterine leiomyosarcoma: analysis of treatment failures and survival. Gynecol Oncol. 1996 Jul;62(1):25-32. doi: 10.1006/gyno.1996.0185. PMID: 8690287.
Ricci S, Giuntoli RL 2nd, Eisenhauer E, Lopez MA, Krill L, Tanner EJ 3rd, Gehrig PA, Havrilesky LJ, Secord AA, Levinson K, Frasure H, Celano P, Fader AN. Does adjuvant chemotherapy improve survival for women with early-stage uterine leiomyosarcoma? Gynecol Oncol. 2013 Dec;131(3):629-33. doi: 10.1016/j.ygyno.2013.08.037. Epub 2013 Sep 7. PMID: 24016408.
Tap WD, Jones RL, Van Tine BA, Chmielowski B, Elias AD, Adkins D, Agulnik M, Cooney MM, Livingston MB, Pennock G, Hameed MR, Shah GD, Qin A, Shahir A, Cronier DM, Ilaria R Jr, Conti I, Cosaert J, Schwartz GK. Olaratumab and doxorubicin versus doxorubicin alone for treatment of soft-tissue sarcoma: an open-label phase 1b and randomised phase 2 trial. Lancet. 2016 Jul 30;388(10043):488-97. doi: 10.1016/S0140-6736(16)30587-6. Epub 2016 Jun 9. Erratum in: Lancet. 2016 Jul 30;388(10043):464. PMID: 27291997; PMCID: PMC5647653.
Sutton G, Blessing JA, Malfetano JH. Ifosfamide and doxorubicin in the treatment of advanced leiomyosarcomas of the uterus: a Gynecologic Oncology Group study. Gynecol Oncol. 1996 Aug;62(2):226-9. doi: 10.1006/gyno.1996.0220. PMID: 8751554.
Hensley ML, Blessing JA, Degeest K, Abulafia O, Rose PG, Homesley HD. Fixed-dose rate gemcitabine plus docetaxel as second-line therapy for metastatic uterine leiomyosarcoma: a Gynecologic Oncology Group phase II study. Gynecol Oncol. 2008 Jun;109(3):323-8. doi: 10.1016/j.ygyno.2008.02.024. Epub 2008 Apr 18. PMID: 18394689; PMCID: PMC2692926.
van der Graaf WT, Blay JY, Chawla SP, Kim DW, Bui-Nguyen B, Casali PG, Schöffski P, Aglietta M, Staddon AP, Beppu Y, Le Cesne A, Gelderblom H, Judson IR, Araki N, Ouali M, Marreaud S, Hodge R, Dewji MR, Coens C, Demetri GD, Fletcher CD, Dei Tos AP, Hohenberger P; EORTC Soft Tissue and Bone Sarcoma Group; PALETTE study group. Pazopanib for metastatic soft-tissue sarcoma (PALETTE): a randomised, double-blind, placebo-controlled phase 3 trial. Lancet. 2012 May 19;379(9829):1879-86. doi: 10.1016/S0140-6736(12)60651-5. Epub 2012 May 16. PMID: 22595799.
Monk BJ, Blessing JA, Street DG, Muller CY, Burke JJ, Hensley ML. A phase II evaluation of trabectedin in the treatment of advanced, persistent, or recurrent uterine leiomyosarcoma: a gynecologic oncology group study. Gynecol Oncol. 2012 Jan;124(1):48-52. doi: 10.1016/j.ygyno.2011.09.019. Epub 2011 Oct 13. PMID: 21996263; PMCID: PMC4497524.
Asano H, Isoe T, Ito YM, Nishimoto N, Watanabe Y, Yokoshiki S, Watari H. Status of the Current Treatment Options and Potential Future Targets in Uterine Leiomyosarcoma: A Review. Cancers (Basel). 2022 Feb 24;14(5):1180. doi: 10.3390/cancers14051180. PMID: 35267488; PMCID: PMC8909836.
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