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Modern multimodality management of patients with caval leiomyosarcoma: New treatment paradigms and potential molecular insights.
- Source :
-
Journal of surgical oncology [J Surg Oncol] 2021 Jun; Vol. 123 (7), pp. 1618-1623. Date of Electronic Publication: 2021 Mar 02. - Publication Year :
- 2021
-
Abstract
- Background and Objectives: Caval leiomyosarcomas (cLMS) are rare soft tissue sarcomas historically associated with high recurrence rates and poor prognosis. While radical resection remains the mainstay of therapy for cLMS, new systemic therapies have presented opportunities for multimodality treatment. We examined the clinical outcomes of patients with cLMS treated with modern, multimodality approaches, and compared their outcomes to those of patients with noncaval retroperitoneal LMS (ncLMS).<br />Methods: A retrospective, single-institution review identified all patients diagnosed with primary retroperitoneal LMS from 2012 to 2018. Radiographic and pathologic review distinguished patients with cLMS and ncLMS. Standard clinicopathologic variables and response to chemotherapy (when applicable) were analyzed. Primary endpoints were overall (OS) and progression-free survival (PFS).<br />Results: Eleven patients with cLMS were identified. Median tumor size was 7.5 cm (IQR, 5.0-14.3 cm); all patients had Stage II/III disease. Seven patients received neoadjuvant chemotherapy. Nine cLMS patients underwent R0/R1 resection; two did not complete resection. Six patients received adjuvant systemic therapy. Twenty patients with ncLMS were treated during the same period. No statistical intergroup differences were noted in tumor size, pathologic grade, stage, or resection margin status. Patients with ncLMS were less likely to receive neoadjuvant (10% vs. 64%) and adjuvant chemotherapy (30% vs. 55%). Two-year OS (81% vs. 78%; p = NS) and PFS (55% vs. 46%; p = NS) were comparable between cLMS and ncLMS patients.<br />Conclusions: Multimodality treatment with systemic therapy and aggressive surgical resection may achieve equivalent survival outcomes for patients with cLMS versus similar ncLMS. We recommend that all patients with cLMS be evaluated for multidisciplinary treatment. Genomic and proteomic expression profiling may identify novel or targetable mutations.<br /> (© 2021 Wiley Periodicals LLC.)
- Subjects :
- Antibodies, Monoclonal administration & dosage
Cohort Studies
Dacarbazine administration & dosage
Doxorubicin administration & dosage
Female
Humans
Ifosfamide administration & dosage
Leiomyosarcoma genetics
Leiomyosarcoma pathology
Male
Middle Aged
Neoadjuvant Therapy
Neoplasm Staging
Retroperitoneal Neoplasms genetics
Retroperitoneal Neoplasms pathology
Retrospective Studies
Vascular Neoplasms genetics
Vascular Neoplasms pathology
Vena Cava, Inferior surgery
Antineoplastic Combined Chemotherapy Protocols therapeutic use
Leiomyosarcoma drug therapy
Leiomyosarcoma surgery
Retroperitoneal Neoplasms drug therapy
Retroperitoneal Neoplasms surgery
Vascular Neoplasms drug therapy
Vascular Neoplasms surgery
Vena Cava, Inferior pathology
Subjects
Details
- Language :
- English
- ISSN :
- 1096-9098
- Volume :
- 123
- Issue :
- 7
- Database :
- MEDLINE
- Journal :
- Journal of surgical oncology
- Publication Type :
- Academic Journal
- Accession number :
- 33650695
- Full Text :
- https://doi.org/10.1002/jso.26442