Long-term outcomes after cytoreductive surgery and hyperthermic perioperative chemotherapy for morcellated uterine leiomyosarcoma: case series

Abstract

<h3>Objectives:</h3> Uterine leiomyosarcoma (uLMS) is a rare aggressive malignant mesenchymal tumor with high risk of recurrence and poor prognosis regardless of stage. If the tumor was morcellated, the oncologist will encounter special problems that require aggressive management of peritoneal metastases. Hyperthermic intraperitoneal chemotherapy (HIPEC) is an intraoperative intraperitoneal chemotherapy administration under hyperthermic condition. Early postoperative intraperitoneal chemotherapy (EPIC) is a second perioperative regional chemotherapy with a goal to eradicate peritoneal metastatic disease. These treatments are possible following a complete cytoreduction surgery (CRS). Only few studies have evaluated outcomes in patients with morcellated uLMS who underwent HIPEC and/or EPIC following CRS. The purpose of the study is to evaluate the long-term outcomes in patients with morcellated uLMS who underwent CRS and HIPEC plus EPIC. <h3>Methods:</h3> We previously reported short-term outcomes (median 14.5 months) in six patients who underwent CRS and HIPEC in an attempt to successfully manage the disseminated disease following morcellation. We reviewed patient demographics, tumor characteristics, treatment history, perioperative complications and outcomes. The grade of the malignancy, peritoneal cancer index (PCI), and completeness of cytoreduction score (CC score) were available for all patients. <h3>Results:</h3> Six patients with morcellated uLMS who underwent CRS and HIPEC were identified in our database. HIPEC was used for 90 minutes following the CRS in the operating room. The regimen consisted of cisplatin 50 mg/m² and doxorubicin 15 mg/m² by intraperitoneal instillation that was manually distributed into the abdominal and pelvic space and maintained at 42.5?. Of the six patients, five patients also received EPIC.Mean age at CRS followed by HIPEC was 49 years (range 40-62) and mean interval from the initial surgery was 17 months (range 1 month to 7 years). The mean PCI was 18 and a CC-0 cytoreduction was achieved in all patients. The 3-year overall survival was 50% and 5-year overall survival was 33% with the median follow-up of 30 months (range 5 months to 73 months). A low grade of sarcoma and a low PCI suggested a favorable outcome. <h3>Conclusions:</h3> Our case series suggests that CRS and HIPEC plus EPIC is well-tolerated and may be a therapeutic option for newly diagnosed uterine leiomyosarcoma following morcellation. Therapeutic options for patients with uLMS post-morcellation are limited and further research to eliminate disease dissemination is needed.