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Bertrand T, Faron M, Mercier O, Ngo C, Le Pechoux C, Levy A, Issard J, Henon C, Honoré C, Fadel E, Le Cesne A. Vena cava leiomyosarcoma surgery results in a retrospective cohort of 41 patients from two centers. J Surg Oncol 2024. [PMID: 38973131 DOI: 10.1002/jso.27765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 06/14/2024] [Indexed: 07/09/2024]
Abstract
BACKGROUND Leiomyosarcoma of the vena cava (LMS-VC) is a rare entity with poor oncological outcomes and a lack of histological staging prognostic factors. METHODS Outcomes of consecutive patients operated on LMS-VC between March 2003 and May 2022, in two specialized sarcoma centers were reported. RESULT Forty-one patients were identified. Median size of LMS-VC was 9 cm with 68% of complete obstruction. After surgery, severe complication rate was 30%. No postoperative mortality was reported. Microscopic complete excision was obtained for 71% of patients, R1 for 27% and one patient presented an R2 resection. Grade 3 was found in 24%. After a median follow-up of 70 months, 3 years disease-free survival (DFS) and 5 years DFS were 34% and 17%, and 3 years overall survival (OS) and 5 years OS were 74% and 50%. Distant metastasis concerned 54% of recurrences, local 7% and local and distant 5%. Multivariate analysis showed that FNCLCC grade (p < 0.001) and perioperative chemotherapy (p = 0.026) were significant factors for DFS. In multivariate analysis, FNCLCC grade was a significant factor for OS (p = 0.004). DISCUSSION Perioperative chemotherapy may have a role to play in lowering the risk of recurrence for LMS-VC, particularly in high-grade tumor.
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Affiliation(s)
- Thibaud Bertrand
- Department of Surgical Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Matthieu Faron
- Department of Surgical Oncology, Gustave Roussy Cancer Campus, Villejuif, France
- INSERM 1018, CESP, Equipe ONCOSTAT, Université Paris Saclay, Villejuif, France
| | - Olaf Mercier
- Department of Thoracic Surgery and Heart-Lung Transplantation Marie-Lannelongue Hospital, GHPSJ, Le Plessis Robinson, France
| | - Carine Ngo
- Biology and Pathology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Cécile Le Pechoux
- Radiation Oncology Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Antonin Levy
- Radiation Oncology Department, Gustave Roussy Cancer Campus, Villejuif, France
- INSERM 1030, Molecular Radiotherapy and Therapeutic innovations, Université Paris Saclay, Villejuif, France
| | - Justin Issard
- Department of Thoracic Surgery and Heart-Lung Transplantation Marie-Lannelongue Hospital, GHPSJ, Le Plessis Robinson, France
| | - Clémence Henon
- INSERM 1030, Molecular Radiotherapy and Therapeutic innovations, Université Paris Saclay, Villejuif, France
- Medical Oncology Department, Gustave Roussy Cancer Campus, Villejuif, France
| | - Charles Honoré
- Department of Surgical Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - Elie Fadel
- Department of Thoracic Surgery and Heart-Lung Transplantation Marie-Lannelongue Hospital, GHPSJ, Le Plessis Robinson, France
| | - Axel Le Cesne
- INSERM 1030, Molecular Radiotherapy and Therapeutic innovations, Université Paris Saclay, Villejuif, France
- Medical Oncology Department, Gustave Roussy Cancer Campus, Villejuif, France
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Castellanos LD, Tabbara MM, Livingstone AS, Salerno TA, Gonzalez J, Ciancio G. Unresectable leiomyosarcoma of the inferior vena cava with right atrium tumor thrombus: when to deem this tumor inoperable? A case report and literature review. Front Oncol 2024; 13:1331896. [PMID: 38282675 PMCID: PMC10811722 DOI: 10.3389/fonc.2023.1331896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 12/04/2023] [Indexed: 01/30/2024] Open
Abstract
Leiomyosarcomas (LMS) of the inferior vena cava (IVC) are a rare form of retroperitoneal malignancy, and their venous extension to the right atrium is an even rarer event. These tumors pose a unique surgical challenge and often require a multidisciplinary team-based approach for their surgical treatment. We present a case of a 68-year-old man with primary LMS of the IVC with a tumor thrombus extending into the right atrium that was initially deemed inoperable. After extensive neoadjuvant chemo-radiation with minimal tumor effect, the patient underwent en bloc surgical resection of the tumor along with removal of the infrarenal IVC and right kidney and adrenal without the need for cardiopulmonary bypass. This case demonstrates the successful management of a primary LMS of the IVC with right atrial extension using a multimodal approach of neoadjuvant chemo-radiation and en bloc surgical resection without cardiopulmonary bypass. This strategy may offer a curative option for selected patients with these rare and aggressive tumors, improving their survival and quality of life.
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Affiliation(s)
- Luis D. Castellanos
- Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
- Miami Transplant Institute, Jackson Health System, Miami, FL, United States
| | - Marina M. Tabbara
- Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
- Miami Transplant Institute, Jackson Health System, Miami, FL, United States
| | - Alan S. Livingstone
- Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
- Division of Surgical Oncology, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Tomas A. Salerno
- Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
- Division of Cardiothoracic Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Javier Gonzalez
- Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Gaetano Ciancio
- Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
- Miami Transplant Institute, Jackson Health System, Miami, FL, United States
- Department of Urology, Leonard M. Miller School of Medicine, University of Miami, Miami, FL, United States
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3
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Goodsell KE, Sharib JM, Pillarisetty VG, Sham JG. Leiomyosarcoma of the inferior vena cava: An uncommon malignancy requiring unique reconstructive approaches. Am J Surg 2023; 226:286-289. [PMID: 36959023 DOI: 10.1016/j.amjsurg.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/11/2023] [Accepted: 03/03/2023] [Indexed: 03/10/2023]
Abstract
Surgery is considered for patients without metastatic disease and with resectable primary tumor. Pre-operatively, high quality imaging is reviewed to determine the likely extent of resection, specifically including the need for potential en-bloc resection of adjacent organs. In cases where up-front surgical approach would expose the patient to excessive morbidity (such as bilateral nephrectomy, multi-visceral resection, or prohibitively high risk of positive margins), neoadjuvant chemotherapy and/or chemoradiotherapy is considered. Though data are sparse in LMS, a neoadjuvant regimen of doxorubicin and dacarbazine is typically considered for borderline resectable tumors at our institution; patients may be treated for up to 4 months with interval imaging every 2 months to evaluate for tumor response. Postoperatively, adjuvant systemic therapy or radiation may be considered for patients with positive surgical margins or high-grade tumors.
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Affiliation(s)
| | - Jeremy M Sharib
- University of Washington Department of Surgery, Seattle, WA, USA; Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Venu G Pillarisetty
- University of Washington Department of Surgery, Seattle, WA, USA; Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Jonathan G Sham
- University of Washington Department of Surgery, Seattle, WA, USA; Fred Hutchinson Cancer Center, Seattle, WA, USA.
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4
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Castro IF, Nunes PHS, Lopes ACX, Lima MC, Conrado RP, Leal RMLV, Goes ACADM, Costa MLV. Surgical resection of retrohepatic inferior vena cava leiomyosarcoma without vascular reconstruction: case report. J Vasc Bras 2023; 22:e20220108. [PMID: 37576732 PMCID: PMC10421572 DOI: 10.1590/1677-5449.202201081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 10/31/2022] [Indexed: 08/15/2023] Open
Abstract
Inferior vena cava leiomyosarcoma (IVCL) is a rare malignant mesenchymal tumor. Surgical treatment is a challenge because it must combine free surgical margins with vascular reconstruction, using prosthetic or autologous grafts, primary suture, or simple ligation without vein reconstruction. The ligation option is possible thanks to the slow growth of the tumor, allowing collateral venous circulation to develop. We present a case of an IVCL treated with radical resection without vascular reconstruction. The patient was a 48-year-old female with abdominal pain in the right upper quadrant, asthenia, and postprandial dyspeptic symptoms. Abdominal tomography revealed a mass with an expansive formation located in the infrahepatic segment of the inferior vena cava and reduced vessel lumen. During surgery, vein clamping did not provoke hemodynamic repercussions, suggesting sufficient collateral circulation formation. It was decided to perform a radical resection of the entire portion of the retrohepatic vena cava and ligate the vena cava without vascular reconstruction. The patient recovered without complications.
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BORGHI A, SCOTTO DI UCCIO A, GRONCHI A. Primary malignancy of the inferior vena cava, a review of surgical treatments and outcomes. THE JOURNAL OF CARDIOVASCULAR SURGERY 2022; 63:649-663. [DOI: 10.23736/s0021-9509.22.12418-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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MARTÍN ROMÁN L, FERNÁNDEZ MARTÍNEZ M, PROSPERI A, LOZANO P, VÁSQUEZ W, PALENCIA N, GONZÁLEZ BAYÓN L. Multimodal approach of leiomyosarcoma of the inferior vena cava: case report and literature review of main points of controversy. Chirurgia (Bucur) 2022. [DOI: 10.23736/s0394-9508.21.05373-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pan J, Qiu CY, He YY, Xue X, Li DL, Tian L, Cheng F, Wu ZH, Zhang HK. A 10-year experience of leiomyosarcoma of the inferior vena cava. Phlebology 2022; 37:572-578. [PMID: 35570826 DOI: 10.1177/02683555221101706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Leiomyosarcoma of the inferior vena cava (IVC) is rare. The study reviewed patients with IVC leiomyosarcoma in our hospital in the past ten years. METHODS Twenty patients diagnosed with IVC leiomyosarcoma between October 2010 and October 2020 were enrolled. Their clinical manifestations, treatments, and follow-up results were analyzed. RESULTS The sarcoma was located in the lower IVC segment in six patients, with 13 in the middle and one in the upper IVC segment. Eighteen patients underwent R0 resection. After resection, 16 patients (80%) had primary repair of the IVC, while four patients underwent ligation. During a mean follow-up of 37.7 months, seven patients died due to tumor metastasis, four patients were alive with the tumor recurrence and other nine patients were alive without recurrence. CONCLUSION The management of the IVC after tumor resection depended on the tumor location and size. R0 resection provided a chance for long term survival.
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Affiliation(s)
- Jun Pan
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, 71069Zhejiang University, Hangzhou, People's Republic of China
| | - Chen-Yang Qiu
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, 71069Zhejiang University, Hangzhou, People's Republic of China
| | - Yang-Yan He
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, 71069Zhejiang University, Hangzhou, People's Republic of China
| | - Xing Xue
- Department of Radiology, The First Affiliated Hospital, School of Medicine, 71069Zhejiang University, Hangzhou, People's Republic of China
| | - Dong-Lin Li
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, 71069Zhejiang University, Hangzhou, People's Republic of China
| | - Lu Tian
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, 71069Zhejiang University, Hangzhou, People's Republic of China
| | - Fei Cheng
- Department of Pathology, The First Affiliated Hospital, School of Medicine, 71069Zhejiang University, Hangzhou, People's Republic of China
| | - Zi-Heng Wu
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, 71069Zhejiang University, Hangzhou, People's Republic of China
| | - Hong-Kun Zhang
- Department of Vascular Surgery, The First Affiliated Hospital, School of Medicine, 71069Zhejiang University, Hangzhou, People's Republic of China
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Wang S, Li Y, Yang Q, Zhang X, Cheng Y, Li Z, Wang J, Zeng Q. Surgery Treatment of Primary Tumors of the Inferior Vena Cava. Front Med (Lausanne) 2022; 9:770967. [PMID: 35308557 PMCID: PMC8924448 DOI: 10.3389/fmed.2022.770967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 01/19/2022] [Indexed: 12/04/2022] Open
Abstract
Background Primary tumor of the inferior vena cava is a rare tumor, which arises from the smooth muscle of vascular walls. Surgery appears the only curative treatment. However, the optimal surgical methods and surgical management are not well-studied. In this article, we reviewed the successful treatment experience of patients in our center who had resection of primary tumor of the inferior vena cava and reviewed the relevant literature. Methods Four cases of patients who undergoing initial resection of primary tumors of the inferior vena cava from September 2017 to August 2021 in the Second Affiliated Hospital of Nanchang University were screened and followed up. They were discussed and cases reported in this field were reviewed. Results Among the four patients, three of them were female. The median age of the disease is 53.75 years (range 45–60 years). After surgical treatment, tumors were removed in all patients, and some patients had reconstruction of inferior vena cava. There were no disease-specific deaths, no serious complications, and no recurrence during follow-up in these cases. Conclusions Careful preoperative examination, correct surgical treatment methods, and multidisciplinary collaboration can lead to safe and successful operations, which improve the survival rate of patients.
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Affiliation(s)
- Shizhi Wang
- Department of Vascular Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yuqiu Li
- Queen Mary College of Nanchang University, Nanchang, China
| | - Qijun Yang
- Queen Mary College of Nanchang University, Nanchang, China
| | - Xue Zhang
- Queen Mary College of Nanchang University, Nanchang, China
| | - Yunqi Cheng
- Queen Mary College of Nanchang University, Nanchang, China
| | - Zimeng Li
- School of Public Health, Nanchang University, Nanchang, China
| | - Jingyi Wang
- School of Public Health, Nanchang University, Nanchang, China
| | - Qingfu Zeng
- Department of Vascular Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
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9
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Goel M, Mohan A, Patkar S, Gala K, Shetty N, Kulkarni S, Dhareshwar J. Leiomyosarcoma of inferior vena cava (IVC): do we really need to reconstruct IVC post resection? Single institution experience. Langenbecks Arch Surg 2022; 407:1209-1216. [PMID: 35022833 DOI: 10.1007/s00423-021-02408-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 12/08/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Inferior vena cava (IVC) leiomyosarcomas (LMS) are a rare group of retroperitoneal tumors. R0 surgical resection is the only curative modality of treatment. IVC resection for retroperitoneal sarcoma is a complex surgery with no definitive guidelines for reconstruction. METHODS Retrospective review of all patients who underwent surgical resection of primary leiomyosarcoma of the IVC requiring resection from 2010 to 2020 at our tertiary care center was performed. RESULTS Among 24 patients who required IVC resection for LMS, only 7 (29%) required reconstruction of IVC. According to Clavien-Dindo classification, there was one grade 3 or more morbidity and 1 post-operative mortality. Seventeen patients underwent R0 resection whereas 7 patients had R1 resection on final histopathology. At a median follow-up of 25 months (range 8-91 months), the median OS was 40 months with median DFS of 28 months. Two patients presented with local recurrence while 13 patients developed systemic recurrence on follow-up. CONCLUSION Careful preoperative multidisciplinary planning can make IVC resection without reconstruction feasible with acceptable perioperative morbidity, mortality, and oncological outcomes for IVC LMS.
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Affiliation(s)
- Mahesh Goel
- GI & HPB Service, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Ernest Borges Marg, Parel, Mumbai, 400 012, India
| | - Anand Mohan
- GI & HPB Service, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Ernest Borges Marg, Parel, Mumbai, 400 012, India
| | - Shraddha Patkar
- GI & HPB Service, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Ernest Borges Marg, Parel, Mumbai, 400 012, India.
| | - Kunal Gala
- Department of Interventional Radiology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Nitin Shetty
- Department of Interventional Radiology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Suyash Kulkarni
- Department of Interventional Radiology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Jayesh Dhareshwar
- Department of Vascular Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
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Wang MX, Menias CO, Elsherif SB, Segaran N, Ganeshan D. Current update on IVC leiomyosarcoma. Abdom Radiol (NY) 2021; 46:5284-5296. [PMID: 34415408 DOI: 10.1007/s00261-021-03256-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 08/14/2021] [Accepted: 08/16/2021] [Indexed: 12/22/2022]
Abstract
Primary leiomyosarcoma of the inferior vena cava (IVC) is a rare soft tissue sarcoma associated with poor prognosis. Patients are often asymptomatic or present with nonspecific abdominal symptoms, which delays initial diagnosis and contributes to poor oncologic outcome. Key imaging modalities include ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI). Characteristic imaging features include imperceptible caval lumen, dilation of the IVC, heterogeneous enhancement of the tumor, and development of extensive collateral circulation. Surgical resection is the mainstay of treatment, while chemotherapy and/or radiation may serve as therapy adjuncts. This article reviews the pathology, clinical findings, imaging features and management of IVC leiomyosarcoma.
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Affiliation(s)
- Mindy X Wang
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Christine O Menias
- Department of Radiology, Mayo Clinic in Arizona, 13400 E. Shea Blvd., Scottsdale, AZ, 85259, USA
| | - Sherif B Elsherif
- Department of Radiology, UF College of Medicine-Jacksonville, 653-1 8th St W, Jacksonville, FL, 32209, USA
| | - Nicole Segaran
- Department of Radiology, Mayo Clinic in Arizona, 13400 E. Shea Blvd., Scottsdale, AZ, 85259, USA
| | - Dhakshinamoorthy Ganeshan
- Unit 1473, Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030-4009, USA.
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Zhou M, Javadi C, Charville GW, Bui NQ, Harris EJ, Poultsides GA, Norton JA, Visser B, Lee B, Dua MM, Ganjoo KN. Surgical resection of leiomyosarcoma of the inferior vena cava: A case series and literature review. Surg Oncol 2021; 39:101670. [PMID: 34710646 DOI: 10.1016/j.suronc.2021.101670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/21/2021] [Accepted: 10/19/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVES We review our institution's experience in treating leiomyosarcomas involving the inferior vena cava, and we offer guidance on the management. METHODS A text-based search was performed to identify all patients who underwent surgical resection between January 2002 and October 2020. Clinicopathologic data, intraoperative variables, and outcomes were extracted from chart review. RESULTS Twelve of 16 patients (75%) had localized disease; the remaining had limited metastatic disease. Seven of 16 patients (44%) received neoadjuvant chemotherapy or radiation; three patients had partial responses, and four patients had stable disease using RECIST 1.1 criteria. IVC reconstruction was performed in 14 of 16 patients (88%); IVC was ligated for the remaining two patients. Half of all patients had R0 resection on final pathology; the remaining had R1 resections. Progression-free survival (PFS) and overall survival (OS) were not statistically different between patients with R0 and R1 resection. Median PFS was 1.8 years (95% CI 0.89 - not reached); median OS was 6.5 years (1.8 - not reached). Only one patient (6%) experienced local disease recurrence; 4 of 16 patients (25%) experienced disease recurrence distally without local recurrence. CONCLUSIONS Resection of IVC leiomyosarcomas at a sarcoma referral center with experience in vascular reconstruction can lead to many years of recurrence-free survival. Surgical resection should be offered to patients with a low volume of metastatic disease to reduce local complications from the primary tumor, many of which exert significant mass effect on surrounding organs. For patients with metastatic disease or large, high-risk tumors, neoadjuvant chemotherapy can provide a biologic test of disease stability prior to resection.
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Affiliation(s)
- Maggie Zhou
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Greg W Charville
- Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA
| | - Nam Q Bui
- Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - E John Harris
- Department of Surgery, Stanford University Hospital, Stanford, CA, USA
| | | | - Jeffrey A Norton
- Department of Surgery, Stanford University Hospital, Stanford, CA, USA
| | - Brendan Visser
- Department of Surgery, Stanford University Hospital, Stanford, CA, USA
| | - Byrne Lee
- Department of Surgery, Stanford University Hospital, Stanford, CA, USA
| | - Monica M Dua
- Department of Surgery, Stanford University Hospital, Stanford, CA, USA
| | - Kristen N Ganjoo
- Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
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12
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Squires MH, Politano S, Pollock RE, Chen JL, Grignol V. Modern multimodality management of patients with caval leiomyosarcoma: New treatment paradigms and potential molecular insights. J Surg Oncol 2021; 123:1618-1623. [PMID: 33650695 DOI: 10.1002/jso.26442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 12/23/2022]
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). 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). 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. 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.
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Affiliation(s)
- Malcolm H Squires
- Division of Surgical Oncology, Department of Surgery, Levine Cancer Institute, Atrium Health, Charlotte, North Carolina, USA
| | - Stephen Politano
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, Ohio, USA
| | - Raphael E Pollock
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, Ohio, USA
| | - James L Chen
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, Ohio, USA.,Division of Bioinformatics, Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio, USA
| | - Valerie Grignol
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, Ohio, USA
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