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Leiomyosarcoma

An Overview of Etiology, Prognosis, and Treatment Options

  • Therapy In Practice
  • Published:
American Journal of Cancer

Abstract

Approximately 2400 people were diagnosed with leiomyosarcoma in 2004 in the US. This rare tumor of connective tissue is clinically subdivided into uterine and nonuterine leiomyosarcoma. No predisposing factors are known, and presentation is usually related to mass involvement and intrusion of adjacent structures.

Tissue obtained for the initial diagnosis should be of sufficient quantity to evaluate the grade of the tumor, and a full work-up for the extent of disease must include chest, abdomen, and pelvic imaging.

For localized disease, the standard of care remains limited to surgical excision. Radiation therapy can be considered for larger tumors and/or positive margins if anatomically feasible. Adjuvant chemotherapy has not been proven to be effective and remains investigational. Treatment for metastatic disease is palliative. Active agents include doxorubicin, ifosfamide, gemcitabine, and docetaxel. The last two agents in combination have recently been shown to be highly active in uterine leiomyosarcoma in the metastatic setting and are now being further pursued at the Memorial Sloan-Kettering Cancer Center (New York, NY, USA) in both the adjuvant uterine leiomyosarcoma setting and in the nonuterine leiomyosarcoma metastatic setting.

Patients diagnosed with leiomyosarcoma should be referred to specialty sarcoma centers and encouraged to participate in clinical trials.

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Table I
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References

  1. Bell SW, Kempson RL, Hendrickson MR. Problematic uterine smooth muscle neoplasms: a clinicopathologic study of 213 cases. Am J Surg Pathol 1994; 18(6): 535–58

    Article  PubMed  CAS  Google Scholar 

  2. Kelly KL, Craighead PS. Characteristics and management of uterine sarcoma patients treated at the Tom Baker Cancer Centre. Int JGynecol Cancer 2005; 15(1): 132–9

    Article  Google Scholar 

  3. Livi L, Paiar F, Shah N, et al. Uterine sarcoma: twenty-seven years of experience. Int J Radiat Oncol Biol Phys 2003; 57(5): 1366–73

    Article  PubMed  CAS  Google Scholar 

  4. American Cancer Society. Statistics for 2006 [online]. Available from URL: http://www.cancer.org/docroot/stt/stt_0.asp [Accessed 2006 Feb 23]

  5. Wang R, Lu YJ, Fisher C, et al. Characterization of chromosome aberrations associated with soft-tissue leiomyosarcomas by twenty-four-color karyotyping and comparative genomic hybridization analysis. Genes Chromosomes Cancer 2001; 31(1): 54–64

    Article  PubMed  Google Scholar 

  6. Cance WG, Brennan MF, Dudas ME, et al. Altered expression of the retinoblastoma gene product in human sarcomas. N Engl J Med 1990; 323(21): 1457–62

    Article  PubMed  CAS  Google Scholar 

  7. Latres E, Drobnjak M, Pollack D, et al. Chromosome 17 abnormalities and TP53 mutations in adult soft tissue sarcomas. Am J Pathol 1994; 145(2): 345–55

    PubMed  CAS  Google Scholar 

  8. Brady MS, Gaynor JJ, Brennan MF. Radiation-associated sarcoma of bone and soft tissue. Arch Surg 1992; 127(12): 1379–85

    Article  PubMed  CAS  Google Scholar 

  9. Wiklund K, Dich J, Holm LE. Soft tissue sarcoma risk in Swedish licensed pesticide applicators. J Occup Med 1988; 30(10): 801–4

    Article  PubMed  CAS  Google Scholar 

  10. Zahm SH, Ward MH, Blair A. Pesticides and cancer. Occup Med 1997; 12(2): 269–89

    PubMed  CAS  Google Scholar 

  11. Bosetti C, La Vecchia C, Lipworth L, et al. Occupational exposure to vinyl chloride and cancer risk: a review of the epidemiologic literature. Eur J Cancer Prev 2003; 12(5): 427–30

    Article  PubMed  CAS  Google Scholar 

  12. Silva EG, Tornos CS, Follen-Mitchell M. Malignant neoplasms of the uterine corpus in patients treated for breast carcinoma: the effects of tamoxifen. Int J Gynecol Pathol 1994; 13(3): 248–58

    Article  PubMed  CAS  Google Scholar 

  13. Wickerham DL, Fisher B, Wolmark N, et al. Association of tamoxifen and uterine sarcoma. J Clin Oncol 2002; 20(11): 2758–60

    PubMed  Google Scholar 

  14. Chlebowski RT, Col N, Winer EP, et al. American Society of Clinical Oncology technology assessment of pharmacologic interventions for breast cancer risk reduction including tamoxifen, raloxifene, and aromatase inhibition. J Clin Oncol 2002; 20(15): 3328–43

    Article  PubMed  CAS  Google Scholar 

  15. O’Regan RM, Jordan VC. The evolution of tamoxifen therapy in breast cancer: selective oestrogen-receptor modulators and downregulators. Lancet Oncol 2002; 3(4): 207–14

    Article  PubMed  Google Scholar 

  16. Cramer SF, Patel A. The frequency of uterine leiomyomas. Am J Clin Pathol 1990; 94(4): 435–8

    PubMed  CAS  Google Scholar 

  17. Quade BJ, Wang TY, Sornberger K, et al. Molecular pathogenesis of uterine smooth muscle tumors from transcriptional profiling. Genes Chromosomes Cancer 2004; 40(2): 97–108

    Article  PubMed  CAS  Google Scholar 

  18. Leibsohn S, d’Ablaing G, Mishell Jr DR, et al. Leiomyosarcoma in a series of hysterectomies performed for presumed uterine leiomyomas. Am J Obstet Gynecol 1990; 162(4): 968–76

    PubMed  CAS  Google Scholar 

  19. Worthington JL, Balfe DM, Lee JK, et al. Uterine neoplasms: MR imaging. Radiology 1986; 159(3): 725–30

    PubMed  CAS  Google Scholar 

  20. Sutton GP, Blessing JA, Manetta A, et al. Gynecologic Oncology Group studies with ifosfamide. Semin Oncol 1992; 19(6 Suppl. 12): 31–4

    PubMed  CAS  Google Scholar 

  21. Brenner PF. Differential diagnosis of abnormal uterine bleeding. Am J Obstet Gynecol 1996; 175(3 Pt 2): 766–9

    Article  PubMed  CAS  Google Scholar 

  22. Kevorkian J, Cento DP. Leiomyosarcoma of large arteries and veins. Surgery 1973;73(3): 390–400

    PubMed  CAS  Google Scholar 

  23. Gustafson P, Willen H, Baldetorp B, et al. Soft tissue leiomyosarcoma: a population-based epidemiologic and prognostic study of 48 patients, including cellular DNA content. Cancer 1992; 70(1): 114–9

    Article  PubMed  CAS  Google Scholar 

  24. Hollenbeck ST, Grobmyer SR, Kent KC, et al. Surgical treatment and outcomes of patients with primary inferior vena cava leiomyosarcoma. J Am Coll Surg 2003; 197(4): 575–9

    Article  PubMed  Google Scholar 

  25. Spencer JM, Amonette RA. Tumors with smooth muscle differentiation. Dermatol Surg 1996; 22(9): 761–8

    Article  PubMed  CAS  Google Scholar 

  26. Pitcher ME, Fish S, Thomas JM. Management of soft tissue sarcoma. Br J Surg 1994; 81(8): 1136–9

    Article  PubMed  CAS  Google Scholar 

  27. Trovik CS, Bauer HC, Brosjo O, et al. Fine needle aspiration (FNA) cytology in the diagnosis of recurrent soft tissue sarcoma. Cytopathology 1998; 9(5): 320–8

    Article  PubMed  CAS  Google Scholar 

  28. Rydholm A. Soft tissue lesions in adults: biopsy — yes or no? Ann Oncol 1992; 3 Suppl. 2: S57–8

    Article  PubMed  Google Scholar 

  29. Fletcher C, Unni K, Mertens F. World Health Organization classification of tumours. Lions: IARC Press, 2002

    Google Scholar 

  30. Greene F, Page DL, Fleming ID, et al, editors. AJCC cancer staging manual. 6thed. New York (NY): Springer, 2002

    Google Scholar 

  31. Hajdu S. Pathology of soft tissue tumors. Philadelphia (PA): Lea & Febiger, 1979

    Google Scholar 

  32. vanUnnik JA, Coindre JM, Contesso C, et al. Grading of soft tissue sarcomas: experience of the EORTC Soft Tissue and Bone Sarcoma Group. Eur J Cancer 1993; 29A(15): 2089–93

    Article  PubMed  Google Scholar 

  33. Drobnjak M, Latres E, Pollack D, et al. Prognostic implications of p53 nuclear overexpression and high proliferation index of Ki-67 in adult soft-tissue sarcomas. J Natl Cancer Inst 1994; 86(7): 549–54

    Article  PubMed  CAS  Google Scholar 

  34. Demas BE, Heelan RT, Lane J, et al. Soft-tissue sarcomas of the extremities: comparison of MR and CT in determining the extent of disease. AJR Am J Roentgenol 1988; 150(3): 615–20

    PubMed  CAS  Google Scholar 

  35. Panicek DM, Gatsonis C, Rosenthal DI, et al. CT and MR imaging in the local staging of primary malignant musculoskeletal neoplasms: report of the Radiology Diagnostic Oncology Group. Radiology 1997; 202(1): 237–46

    PubMed  CAS  Google Scholar 

  36. Umesaki N, Tanaka T, Miyama M, et al. Positron emission tomography with(18)F-fluorodeoxyglucose of uterine sarcoma: a comparison with magnetic resonance imaging and power Doppler imaging. Gynecol Oncol 2001; 80(3): 372–7

    Article  PubMed  CAS  Google Scholar 

  37. Vernon CB, Eary JF, Rubin BP, et al. FDG PET imaging guided re-evaluation of histopathologic response in a patient with high-grade sarcoma. Skeletal Radiol 2003; 32(3): 139–42

    Article  PubMed  Google Scholar 

  38. Fong Y, Coit DG, Woodruff JM, et al. Lymph node metastasis from soft tissue sarcoma in adults: analysis of data from a prospective database of 1772 sarcoma patients. Ann Surg 1993; 217(1): 72–7

    Article  PubMed  CAS  Google Scholar 

  39. Leitao MM, Sonoda Y, Brennan MF, et al. Incidence of lymph node and ovarian metastases in leiomyosarcoma of the uterus. Gynecol Oncol 2003; 91(1): 209–12

    Article  PubMed  Google Scholar 

  40. Gadd MA, Casper ES, Woodruff JM, et al. Development and treatment of pulmonary metastases in adult patients with extremity soft tissue sarcoma. Ann Surg 1993; 218(6): 705–12

    Article  PubMed  CAS  Google Scholar 

  41. Anraku M, Yokoi K, Nakagawa K, et al. Pulmonary metastases from uterine malignancies: results of surgical resection in 133 patients. J Thorac Cardiovasc Surg 2004; 127(4): 1107–12

    Article  PubMed  Google Scholar 

  42. Youssef E, Fontanesi J, Mott M, et al. Long-term outcome of combined modality therapy in retroperitoneal and deep-trunk soft-tissue sarcoma: analysis of prognostic factors. Int J Radiat Oncol Biol Phys 2002; 54(2): 514–9

    Article  PubMed  Google Scholar 

  43. Pisters PW, O’Sullivan B. Retroperitoneal sarcomas: combined modality treatment approaches. Curr Opin Oncol 2002; 14(4): 400–5

    Article  PubMed  Google Scholar 

  44. Russell WO, Cohen J, Enzinger F, et al. A clinical and pathological staging system for soft tissue sarcomas. Cancer 1977; 40: 1562–70

    Article  PubMed  CAS  Google Scholar 

  45. Shepherd JH. Revised FIGO staging for gynaecological cancer. Br J Obstet Gynaecol 1989; 96(8): 889–92

    Article  PubMed  CAS  Google Scholar 

  46. Memorial Sloan-Kettering Cancer Center. Sarcoma nomogram [online]. Available from URL: http://www.mskcc.org/mskcc/html/6181.cfm [Accessed 2006 Feb27]

  47. Stojadinovic A, Leung DH, Allen P, et al. Primary adult soft tissue sarcoma: time-dependent influence of prognostic variables. J Clin Oncol 2002; 20(21): 4344–52

    Article  PubMed  Google Scholar 

  48. Cormier JN, Huang X, Xing Y, et al. Cohort analysis of patients with localized, high-risk, extremity soft tissue sarcoma treated at two cancer centers: chemotherapy-associated outcomes. J Clin Oncol 2004; 22(22): 4567–74

    Article  PubMed  Google Scholar 

  49. Major FJ, Blessing JA, Silverberg SG, et al. Prognostic factors in early-stage uterine sarcoma: a Gynecologic Oncology Group study. Cancer 1993; 71(4 Suppl.): 1702–9

    Article  PubMed  CAS  Google Scholar 

  50. Nordal RR, Kristensen GB, Kaern J, et al. The prognostic significance of surgery, tumor size, malignancy grade, menopausal status, and DNA ploidy in endometrial stromal sarcoma. Gynecol Oncol 1996; 62(2): 254–9

    Article  PubMed  CAS  Google Scholar 

  51. Nordal RR, Kristensen GB, Kaern J, et al. The prognostic significance of stage, tumor size, cellular atypia and DNA ploidy in uterine leiomyosarcoma. Acta Oncol 1995; 34(6): 797–802

    Article  PubMed  CAS  Google Scholar 

  52. Hornback NB, Omura G, Major FJ. Observations on the use of adjuvant radiation therapy in patients with stage I and II uterine sarcoma. Int J Radiat Oncol Biol Phys 1986; 12(12): 2127–30

    Article  PubMed  CAS  Google Scholar 

  53. Ferrer F, Sabater S, Farrus B, et al. Impact of radiotherapy on local control and survival in uterine sarcomas: a retrospective study from the Grup Oncologic Catala-Occita. Int J Radiat Oncol Biol Phys 1999; 44(1): 47–52

    Article  PubMed  CAS  Google Scholar 

  54. Omura GA, Blessing JA, Major F, et al. A randomized clinical trial of adjuvant adriamycin in uterine sarcomas: a Gynecologic Oncology Group study. J Clin Oncol 1985; 3(9): 1240–5

    PubMed  CAS  Google Scholar 

  55. Hensley ML, Maki R, Venkatraman E, et al. Gemcitabine and docetaxel in patients with unresectable leiomyosarcoma: results of a phase II trial. J Clin Oncol 2002; 20(12): 2824–31

    Article  PubMed  CAS  Google Scholar 

  56. Thigpen JT, Blessing JA, Beecham J, et al. Phase II trial of cisplatin as first-line chemotherapy in patients with advanced or recurrent uterine sarcomas: a Gynecologic Oncology Group study. J Clin Oncol 1991; 9(11): 1962–6

    PubMed  CAS  Google Scholar 

  57. Muss HB, Bundy BN, Adcock L, et al. Mitoxantrone in the treatment of advanced uterine sarcoma: a phase II trial of the Gynecologic Oncology Group. Am J Clin Oncol 1990; 13(1): 32–4

    Article  PubMed  CAS  Google Scholar 

  58. Asbury R, Blessing JA, Smith DM, et al. Aminothiadiazole in the treatment of advanced leiomyosarcoma of the uterine corpus: a Gynecologic Oncology Group study. Am J Clin Oncol 1995; 18(5): 397–9

    Article  PubMed  CAS  Google Scholar 

  59. Rose PG, Blessing JA, Soper JT, et al. Prolonged oral etoposide in recurrent or advanced leiomyosarcoma of the uterus: a Gynecologic Oncology Group study. Gynecol Oncol 1998; 70(2): 267–71

    Article  PubMed  CAS  Google Scholar 

  60. Sutton GP, Blessing JA, Barrett RJ, et al. Phase II trial of ifosfamide and mesna in leiomyosarcoma of the uterus: a Gynecologic Oncology Group study. Am J Obstet Gynecol 1992; 166(2): 556–9

    PubMed  CAS  Google Scholar 

  61. Slayton RE, Blessing JA, Angel C, et al. Phase II trial of etoposide in the management of advanced and recurrent leiomyosarcoma of the uterus: a Gynecologic Oncology Group Study. Cancer Treat Rep 1987; 71(12): 1303–4

    PubMed  CAS  Google Scholar 

  62. Omura GA, Major FJ, Blessing JA, et al. A randomized study of adriamycin with and without dimethyl triazenoimidazole carboxamide in advanced uterine sarcomas. Cancer 1983; 52(4): 626–32

    Article  PubMed  CAS  Google Scholar 

  63. Currie J, Blessing JA, Muss HB, et al. Combination chemotherapy with hydroxy-urea, dacarbazine (DTIC), and etoposide in the treatment of uterine leiomyosarcoma: a Gynecologic Oncology Group study. Gynecol Oncol 1996; 61(1): 27–30

    Article  PubMed  CAS  Google Scholar 

  64. Sutton G, Blessing JA, Malfetano JH. Ifosfamide and doxorubicin in the treatment of advanced leiomyosarcomas of the uterus: a Gynecologic Oncology Group study. Gynecol Oncol 1996; 62(2): 226–9

    Article  PubMed  CAS  Google Scholar 

  65. Pisters PW, Harrison LB, Leung DH, et al. Long-term results of a prospective randomized trial of adjuvant brachytherapy in soft tissue sarcoma. J Clin Oncol 1996; 14(3): 859–68

    PubMed  CAS  Google Scholar 

  66. Yang JC, Chang AE, Baker AR, et al. Randomized prospective study of the benefit of adjuvant radiation therapy in the treatment of soft tissue sarcomas of the extremity. J Clin Oncol 1998; 16(1): 197–203

    PubMed  CAS  Google Scholar 

  67. O’Sullivan B, Davis AM, Turcotte R, et al. Preoperative versus postoperative radiotherapy in soft-tissue sarcoma of the limbs: a randomised trial. Lancet 2002; 359(9325): 2235–41

    Article  PubMed  Google Scholar 

  68. Sarcoma Meta-analysis Collaboration. Adjuvant chemotherapy for localised re-sectable soft tissue sarcoma in adults: Sarcoma Meta-analysis Collaboration (SMAC). Cochrane Database Syst Rev 2000; (2): CD001419

  69. Sarcoma Meta-analysis Collaboration. Adjuvant chemotherapy for localised re-sectable soft-tissue sarcoma of adults: meta-analysis of individual data. Lancet 1997; 350(9092): 1647–54

    Article  Google Scholar 

  70. Frustaci S, Gherlinzoni F, DePaoli A, et al. Adjuvant chemotherapy for adult soft tissue sarcomas of the extremities and girdles: results of the Italian randomized cooperative trial. J Clin Oncol 2001; 19(5): 1238–47

    PubMed  CAS  Google Scholar 

  71. Frustaci S, DePaoli A, Bidoli E, el al. Ifosfamide in the adjuvant therapy of soft tissue sarcomas. Oncology 2003; 65Suppl. 2: 80–4

    Article  PubMed  CAS  Google Scholar 

  72. Brodowicz T, Schwameis E, Widder H, et al. Intensifed adjuvant IFADIC chemotherapy for adult soft tissue sarcoma: a prospective randomized feasibility trial. Sarcoma 2000; 4: 151–60

    Article  PubMed  CAS  Google Scholar 

  73. Bramwell VH. Adjuvant chemotherapy for adult soft tissue sarcoma: is there a standard of care? J Clin Oncol 2001; 19(5): 1235–7

    PubMed  CAS  Google Scholar 

  74. Judson I. Systemic therapy of soft tissue sarcoma: an improvement in outcome. Ann Oncol 2004; 15Suppl. 4: iv193–6

    PubMed  Google Scholar 

  75. Borden EC, Amato DA, Rosenbaum C, et al. Randomized comparison of three adriamycin regimens for metastatic soft tissue sarcomas. J Clin Oncol 1987; 5(6): 840–50

    PubMed  CAS  Google Scholar 

  76. Mouridsen HT, Bastholt L, Somers R, et al. Adriamycin versus epirubicin in advanced soft tissue sarcomas: a randomized phase Il/phase III study of the EORTC Soft Tissue and Bone Sarcoma Group. Eur J Cancer Clin Oncol 1987; 23(10): 1477–83

    Article  PubMed  CAS  Google Scholar 

  77. Gottlieb JA, Benjamin RS, Baker LH, et al. Role of DTIC (NSC-45388) in the chemotherapy of sarcomas. Cancer Treat Rep 1976; 60(2): 199–203

    PubMed  CAS  Google Scholar 

  78. vanHoesel QG, Verweij J, Catimel G, et al. Phase II study with docetaxel (Taxotere) in advanced soft tissue sarcomas of the adult: EORTC Soft Tissue and Bone Sarcoma Group. Ann Oncol 1994; 5(6): 539–42

    PubMed  Google Scholar 

  79. Fidias P, Demetri GD, Harmon DC. Navelbine shows activity in previously treated sarcoma patients: phase II results from MGH/Dana-Farber/Partners Cancer Care Study [abstract]. Proc Am Soc Clin Oncol 1998; 17: A1977

    Google Scholar 

  80. Patel SR, Jenkins J, Papadopoulos NE, et al. Preliminary results of a two-arm phase 2 trial of gemcitabine in patients with gastroinstestinal leiomyosarcomas and other soft-tissue sarcomas (STS) [abstract]. Sarcoma 1999; 3(1): 56

    Google Scholar 

  81. Edmonson JH, Ryan LM, Blum RH, et al. Randomized comparison of doxorubicin alone versus ifosfamide plus doxorubicin or mitomycin, doxorubicin, and cisplatin against advanced soft tissue sarcomas. J Clin Oncol 1993; 11(7): 1269–75

    PubMed  CAS  Google Scholar 

  82. vanOosterom AT, Mouridsen HT, Nielsen OS, et al. Results of randomised studies of the EORTC Soft Tissue and Bone Sarcoma Group (STBSG) with two different ifosfamide regimens in first- and second-line chemotherapy in advanced soft tissue sarcoma patients. Eur J Cancer 2002; 38(18): 2397–406

    Article  PubMed  Google Scholar 

  83. Daugaard S. Current soft-tissue sarcoma classifications. Eur J Cancer 2004; 40(4): 543–8

    Article  PubMed  CAS  Google Scholar 

  84. Leu KM, Ostruszka LJ, Shewach D, et al. Laboratory and clinical evidence of synergistic cytotoxicity of sequential treatment with gemcitabine followed by docetaxel in the treatment of sarcoma. J Clin Oncol 2004; 22(9): 1706–12

    Article  PubMed  CAS  Google Scholar 

  85. Loehrer Sr PJ, Sledge Jr GW, Nicaise C, et al. Ifosfamide plus doxorubicin in metastatic adult sarcomas: a multi-institutional phase II trial. J Clin Oncol 1989; 7(11): 1655–9

    PubMed  Google Scholar 

  86. Santoro A, Tursz T, Mouridsenas H, et al. Doxorubicin versus CYVADIC versus doxorubicin plus ifosfamide in first-line treatment of advanced soft tissue sarcomas: a randomized study of the European Organization for Research and Treatment of Cancer Soft Tissue and Bone Sarcoma Group. J Clin Oncol 1995; 13(7): 1537–45

    PubMed  CAS  Google Scholar 

  87. VanGlabbeke M, vanOosterom AT, Oosterhuis JW, et al. Prognostic factors for the outcome of chemotherapy in advanced soft tissue sarcomas: an analysis of 2,185 patients treated with anthracycline containing first-line regimens: an European Organization for Research and Treatment of Cancer Soft Tissue and Bone Sarcoma Study Group. J Clin Oncol 1999; 17(1): 150–7

    PubMed  Google Scholar 

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Acknowledgments

I Matushansky and ML Hensley have no conflicts of interest that are directly relevant to the content of this review. No sources of funding were used to assist in the preparation of this review.

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Matushansky, I., Hensley, M.L. Leiomyosarcoma. Am J Cancer 5, 81–91 (2006). https://doi.org/10.2165/00024669-200605020-00002

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