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.
Similar content being viewed by others
References
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
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
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
American Cancer Society. Statistics for 2006 [online]. Available from URL: http://www.cancer.org/docroot/stt/stt_0.asp [Accessed 2006 Feb 23]
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
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
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
Brady MS, Gaynor JJ, Brennan MF. Radiation-associated sarcoma of bone and soft tissue. Arch Surg 1992; 127(12): 1379–85
Wiklund K, Dich J, Holm LE. Soft tissue sarcoma risk in Swedish licensed pesticide applicators. J Occup Med 1988; 30(10): 801–4
Zahm SH, Ward MH, Blair A. Pesticides and cancer. Occup Med 1997; 12(2): 269–89
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
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
Wickerham DL, Fisher B, Wolmark N, et al. Association of tamoxifen and uterine sarcoma. J Clin Oncol 2002; 20(11): 2758–60
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
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
Cramer SF, Patel A. The frequency of uterine leiomyomas. Am J Clin Pathol 1990; 94(4): 435–8
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
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
Worthington JL, Balfe DM, Lee JK, et al. Uterine neoplasms: MR imaging. Radiology 1986; 159(3): 725–30
Sutton GP, Blessing JA, Manetta A, et al. Gynecologic Oncology Group studies with ifosfamide. Semin Oncol 1992; 19(6 Suppl. 12): 31–4
Brenner PF. Differential diagnosis of abnormal uterine bleeding. Am J Obstet Gynecol 1996; 175(3 Pt 2): 766–9
Kevorkian J, Cento DP. Leiomyosarcoma of large arteries and veins. Surgery 1973;73(3): 390–400
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
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
Spencer JM, Amonette RA. Tumors with smooth muscle differentiation. Dermatol Surg 1996; 22(9): 761–8
Pitcher ME, Fish S, Thomas JM. Management of soft tissue sarcoma. Br J Surg 1994; 81(8): 1136–9
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
Rydholm A. Soft tissue lesions in adults: biopsy — yes or no? Ann Oncol 1992; 3 Suppl. 2: S57–8
Fletcher C, Unni K, Mertens F. World Health Organization classification of tumours. Lions: IARC Press, 2002
Greene F, Page DL, Fleming ID, et al, editors. AJCC cancer staging manual. 6thed. New York (NY): Springer, 2002
Hajdu S. Pathology of soft tissue tumors. Philadelphia (PA): Lea & Febiger, 1979
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
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
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
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
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
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
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
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
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
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
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
Pisters PW, O’Sullivan B. Retroperitoneal sarcomas: combined modality treatment approaches. Curr Opin Oncol 2002; 14(4): 400–5
Russell WO, Cohen J, Enzinger F, et al. A clinical and pathological staging system for soft tissue sarcomas. Cancer 1977; 40: 1562–70
Shepherd JH. Revised FIGO staging for gynaecological cancer. Br J Obstet Gynaecol 1989; 96(8): 889–92
Memorial Sloan-Kettering Cancer Center. Sarcoma nomogram [online]. Available from URL: http://www.mskcc.org/mskcc/html/6181.cfm [Accessed 2006 Feb27]
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
Frustaci S, DePaoli A, Bidoli E, el al. Ifosfamide in the adjuvant therapy of soft tissue sarcomas. Oncology 2003; 65Suppl. 2: 80–4
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
Bramwell VH. Adjuvant chemotherapy for adult soft tissue sarcoma: is there a standard of care? J Clin Oncol 2001; 19(5): 1235–7
Judson I. Systemic therapy of soft tissue sarcoma: an improvement in outcome. Ann Oncol 2004; 15Suppl. 4: iv193–6
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
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
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
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
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
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
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
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
Daugaard S. Current soft-tissue sarcoma classifications. Eur J Cancer 2004; 40(4): 543–8
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
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
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
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
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.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Matushansky, I., Hensley, M.L. Leiomyosarcoma. Am J Cancer 5, 81–91 (2006). https://doi.org/10.2165/00024669-200605020-00002
Published:
Issue Date:
DOI: https://doi.org/10.2165/00024669-200605020-00002