Surgical and oncologic outcomes of hyperthermic intraperitoneal chemotherapy for uterine leiomyosarcoma

Abstract

Objectives: To examine the perioperative and survival outcomes in women with disseminated peritoneal uterine leiomyosarcoma (uLMS) who underwent cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Methods: A systematic review of literature was performed and women with disseminated peritoneal uLMS treated with CRS-HIPEC were analyzed. Perioperative morbidity and mortality rate and oncologic outcomes related to CRS-HIPEC were assessed. Results: Ten studies met the inclusion criteria from 2004-2020, including 8 case series (n=28) and 2 original articles (n=47). Of these, 68 (90.7%) were women with uLMS whereas 7 women were nonuLMS. Among 75 patients, 64 (85.3%) had recurrent disease. The perioperative mortality rate was 4.0% (intraoperative 1.3%, and postoperative 2.7%), and postoperative complications (grade ≥3) rate ranged 21.4-22.2%. With regard to HIPEC regimens (n=75), cisplatin was most frequently used (n=55, 73.3%) followed by melphalan (n=17, 22.7%) and others (n=3, 4.0%). Among two observational studies, the median overall survival after CRS-HIPEC treatment was 29.5-37 months. In one limited comparative effectiveness study (n=13), albeit statistically non-significant, CRS-HIPEC was associated with higher progression-free survival versus CRS alone (3-year rate, 71.4% versus 0%, P=0.10). When the HIPEC regimens were compared, melphalan use was associated with decreased uLMS-related mortality compared to a cisplatin-based regimen, but the association was not statistically significant (hazard ratio 0.35, 95% confidence interval 0.04-3.05, P=0.35). Download : Download high-res image (48KB) Download : Download full-size image Conclusions: CRS-HIPEC appears to be a rare and new treatment approach for disseminated peritoneal uLMS and may be associated with a relatively high surgical mortality. Interpretation of available data on survival is limited due to small sample sizes or the lack of an active comparator, and further study is warranted to examine the survival effect of CRS-HIPEC in disseminated peritoneal uLMS cases.