Leiomyosarcoma of the Inferior Vena Cava With Kidney Invasion

A systematic review of the current management approaches in leiomyosarcoma of inferior vena cava-Results from analysis of 118 cases

INTRODUCTION

Primary intravenous leiomyosarcomas are rare vascular tumors with aggressive disease biology. The diagnosis and management have been challenging as little data exist from large databases.

METHODS

A literature search was done to identify all cases of primary leiomyosarcomas in the last five years. Clinicopathological features and management strategies were evaluated.

RESULTS

The median age was 53 years, predominantly females (2.5:1), presenting as metastases in up to 12.1% cases. Most tumors were locally advanced with a median size of 10cm. Inferior vena cava involvement from renal veins to infrahepatic veins remains the most frequent site (57.1%cases) while nearly half (52.8%) proceeded for surgery without histological proof. Most patients could undergo upfront resection (88.0%) with few patients receiving neoadjuvant chemotherapy (4.3%) or neoadjuvant radiotherapy (2.2%). Significant multivisceral resections included right nephrectomy (41.3%), liver resection (25.7%) and left nephrectomy (2.2%). Most patients (91.8%) needed an inferior vena cava graft placement with remarkable microscopically negative margins (85.5% cases). Doxorubicin and ifosfamide were the most frequently used combination chemotherapy regimens in both pre and postoperative settings with partial responses. The median overall and disease free survival among operated patients was 60 months and 28 months respectively. In multivariate analysis large tumor, extensive inferior vena cava involvement, and need for adjuvant chemotherapy appeared significant predictors for overall survival.

CONCLUSIONS

Aggressive upfront surgical resection with clear margin remains the key for long-term survival. Doxorubicin-based regimens were preferred as neoadjuvant chemotherapy while adjuvant treatment with chemotherapy, radiotherapy, or both may be considered in high-risk patients.

Leiomyosarcoma of the Inferior Vena Cava with Hepatic and Pulmonary Metastases: Case Report

Sarcomas are connective tissue tumors accounting for only 1% of all adult malignancies. Leiomyosarcoma (LMS) is a sarcoma arising from smooth muscle cells, and accounts for 10-20% of all sarcomas. A subtype of LMS are those originating from the smooth muscle of blood vessels. Leiomyosarcoma of the inferior vena cava is a sarcomatous tumor, with less than 350 cases described in the literature. It carries a poor prognosis, with 5- and 10-year survival rates of 31.4% and 7.4%, respectively. We present a case of a 46-year-old female with no significant past medical history presented to the emergency department with mild abdominal pain and distention, early satiety, and weight loss for three weeks, found to have unresectable metastatic leiomyosarcoma of the inferior vena cava.

[Surgical treatment of patients with leiomyosarcoma of inferior vena cava]

AIM

To evaluate the results of surgical treatment of patients with leiomyosarcoma of inferior vena cava.

MATERIAL AND METHODS

For the period 2003-2016 21 patients with leiomyosarcoma of IVC were operated at the abdominal department of Blokhin Russian Cancer Research Center. 23.8% patients (n=5) underwent longitudinal resection of IVC, 23.8% (n=5) - circular resection and ligation of IVC, 23.8% (n=5) - circular resection and ligation of IVC, left renal vein ligation, 9.5% (n=2) - circular resection and replacement of IVC, 9.5% (n=2) - circular resection and replacement of IVC, ligation of left renal vein, 9.5% (n=2) - circular resection and replacement of IVC, left renal vein implantation into the prosthesis.

RESULTS

The incidence of postoperative complications was 38% (n=8). Postoperative mortality was 4.8% (n=1). R1-resection was made in 4.8% patients (n=1). 1- and 2-year recurrence-free survival was 67% and 50% respectively. Overall 1- and 2-year survival was 86% and 68% respectively.

CONCLUSION

In patients with leiomyosarcoma of inferior vena cava surgery is feasible and safe with satisfactory long-term results.