Leiomyosarcoma medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Nima Nasiri, M.D.[2]
Overview
Uterine leiomyosarcoma (LMS) is the most common sarcoma arising from the uterus and comprises approximately 2% of uterine cancers. Patients diagnosed with LMS have a 5-year overall survival ranging from 25-75% . The primary management of LMS is hysterectomy. Adjuvant pelvic radiotherapy has been shown to improve local control and survival of patients with leiomyosarcoma.
Chemotherapy
- Chemotherapy is recommended for individuals who have locally advanced, metastatic, or recurrent disease. Usually in combination with surgical procedures and/or radiation. The treatment is to use drugs to stop the growth of cancer cells either by killing the cells or by stopping them from dividing.[1][2][3]
- Anthracyclines stops the tumor growth by different mechanism such as intercalating into deoxyribonucleic acid (DNA), blocking DNA and ribonucleic acid (RNA) synthesis, also causing DNA breakage by interfering with topoisomerase II activity.
- Most common drugs used as first line treatment of soft tissue sarcoma include combination of ifosfamide and doxorubicin (Adriamycin).
- Surgical resection of localized disease is a mainstay therapeutic strategy.
- In the event tumors have metastasized or spread beyond uterus and not resectable by surgery, cytotoxic chemotherapeutic agents can be used in combination with radiation therapy.
- Some of these chemotherapeutic agents are gemcitabine, docetaxel, ifosfamide, temozolomide, trabectedin, eribulin.
Radiation Therapy
- Radiation therapy may be a useful adjunct to improve local control or where a cancer is inoperable due to the specific location or possible progression of the malignancy.[4]
- It can be used postoperative to help treat known or possible residual disease. Radiation therapy can also be used as a palliative care in cases where extensive metastasis has already occurred.[5]
- Adjuvant pelvic radiotherapy has been shown by some to improve disease-free survival. [6]
- Studies had shown that there is a 38% disease-free survival rate in women receiving adjuvant radiotherapy compared with 18% in women receiving surgery alone.[7]
Novel therapies
Studies have shown that some of the sarcomas express angiogenic factors, such as vascular endothelial growth factor, therefore the use of anti‐angiogenic agents is reasonable as part of the treatment on case basis.[8]
- Thalidomide, an angiogenesis inhibitor, is currently being investigated to be used for the treatment of leiomyosarcoma.
References
- ↑ In, Gino K.; Hu, James S.; Tseng, William W. (2017). "Treatment of advanced, metastatic soft tissue sarcoma: latest evidence and clinical considerations". Therapeutic Advances in Medical Oncology. 9 (8): 533–550. doi:10.1177/1758834017712963. ISSN 1758-8340.
- ↑ Blay JY (2018) Getting up-to-date in the management of soft tissue sarcoma. Future Oncol 14 (10s):3-13. DOI:10.2217/fon-2018-0074 PMID: 29768050
- ↑ (1969) New antiviral drug. Nature 222 (5190):218. PMID: 5778386
- ↑ Sampath, Sagus; Gaffney, David K. (2011). "Role of radiotherapy treatment of uterine sarcoma". Best Practice & Research Clinical Obstetrics & Gynaecology. 25 (6): 761–772. doi:10.1016/j.bpobgyn.2011.06.004. ISSN 1521-6934.
- ↑ Reed NS, Mangioni C, Malmström H, Scarfone G, Poveda A, Pecorelli S et al. (2008) Phase III randomised study to evaluate the role of adjuvant pelvic radiotherapy in the treatment of uterine sarcomas stages I and II: an European Organisation for Research and Treatment of Cancer Gynaecological Cancer Group Study (protocol 55874). Eur J Cancer 44 (6):808-18. DOI:10.1016/j.ejca.2008.01.019 PMID: 18378136
- ↑ Harry, Vanessa N; Narayansingh, Gordon V; Parkin, David E (2007). "Uterine leiomyosarcomas: a review of the diagnostic and therapeutic pitfalls". The Obstetrician & Gynaecologist. 9 (2): 88–94. doi:10.1576/toag.9.2.088.27309. ISSN 1467-2561.
- ↑ Harry, Vanessa N; Narayansingh, Gordon V; Parkin, David E (2007). "Uterine leiomyosarcomas: a review of the diagnostic and therapeutic pitfalls". The Obstetrician & Gynaecologist. 9 (2): 88–94. doi:10.1576/toag.9.2.088.27309. ISSN 1467-2561.
- ↑ Boyar, Michelle S.; Hesdorffer, Mary; Keohan, Mary Louise; Jin, Zhezhen; Taub, Robert N. (2008). "Phase II Study of Temozolomide and Thalidomide in Patients with Unresectable or Metastatic Leiomyosarcoma". Sarcoma. 2008: 1–7. doi:10.1155/2008/412503. ISSN 1357-714X.