Age-Stratified Risk of Unexpected Uterine Sarcoma Following Surgery for Presumed Benign Leiomyoma

Brohl, Andrew S.; Li, Li; Andikyan, Vaagn; Običan, Sarah; Cioffi, Angela; Hao, Ke; Dudley, Joel T.; Ascher‐Walsh, Charles; Kasarskis, Andrew; Maki, Robert G.

doi:10.1634/theoncologist.2014-0361

Cited by 66 publications

(48 citation statements)

References 14 publications

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“…The risk of unexpected LMS increased steadily in ages from the 40s to the 50s (0.11% and 0.36%, respectively), whereas the risk of unexpected ESS decreased steadily in the same period (0.58% and 0.24%, respectively). The risk trend of unexpected LMS and ESS was in accordance with the result of the study by Brohl et al 21 It is obvious that age stratification significantly affects the risk prediction for uterine sarcoma.…”

Section: Preoperative Evaluationsupporting

confidence: 88%

“…Recently, Brohl et al 21 presented that the risk of unexpected uterine sarcoma seemed to be age related and reported that the peak incidences of all uterine sarcoma, LMS, and ESS were in the perimenopausal age range of 45 to 54 years, with ESS peaking in incidence at a slightly younger age than LMS based on a meta-analysis. In the present study, patients with unexpected uterine sarcomas were all in their 40s and 50s and 12 (66.67%) patients were at 45 to 54 years.…”

Section: Preoperative Evaluationmentioning

confidence: 99%

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Clinical Characteristics and Prognosis of Unexpected Uterine Sarcoma After Hysterectomy for Presumed Myoma With and Without Transvaginal Scalpel Morcellation

Zhang

et al. 2016

International Journal of Gynecological Cancer

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Section: Preoperative Evaluationsupporting

confidence: 88%

Section: Preoperative Evaluationmentioning

confidence: 99%

Clinical Characteristics and Prognosis of Unexpected Uterine Sarcoma After Hysterectomy for Presumed Myoma With and Without Transvaginal Scalpel Morcellation

Zhang

et al. 2016

International Journal of Gynecological Cancer

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“…Pre-operatively it is difficult to differentiate benign leiomyomas from malignant LMS and so the surgical approach should be planned accordingly; laparoscopic morcellation is contraindicated for uterine sarcoma due to higher risk of recurrence and metastasis [121–123]. The risk of inadvertent morcellation of a uterine sarcoma increases significantly with age [124], and the US Food and Drug Administration (FDA) released a safety communication concerning the procedure in 2014 [125]. Standard surgical management for non-metastatic disease is total abdominal hysterectomy (TAH) with, or without bilateral salpingo-oophorectomy (BSO).…”

Section: Uterine and Retroperitoneal Sarcomasmentioning

confidence: 99%

UK guidelines for the management of soft tissue sarcomas

Dangoor¹,

et al. 2016

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Soft tissue sarcomas (STS) are rare tumours arising in mesenchymal tissues, and can occur almost anywhere in the body. Their rarity, and the heterogeneity of subtype and location means that developing evidence-based guidelines is complicated by the limitations of the data available. However, this makes it more important that STS are managed by teams, expert in such cases, to ensure consistent and optimal treatment, as well as recruitment to clinical trials, and the ongoing accumulation of further data and knowledge. The development of appropriate guidance, by an experienced panel referring to the evidence available, is therefore a useful foundation on which to build progress in the field. These guidelines are an update of the previous version published in 2010 (Grimer et al. in Sarcoma 2010:506182, 2010). The original guidelines were drawn up following a consensus meeting of UK sarcoma specialists convened under the auspices of the British Sarcoma Group (BSG) and were intended to provide a framework for the multidisciplinary care of patients with soft tissue sarcomas. This current version has been updated and amended with reference to other European and US guidance. There are specific recommendations for the management of selected subtypes of disease including retroperitoneal and uterine sarcomas, as well as aggressive fibromatosis (desmoid tumours) and other borderline tumours commonly managed by sarcoma services. An important aim in sarcoma management is early diagnosis and prompt referral. In the UK, any patient with a suspected soft tissue sarcoma should be referred to one of the specialist regional soft tissues sarcoma services, to be managed by a specialist sarcoma multidisciplinary team. Once the diagnosis has been confirmed using appropriate imaging, plus a biopsy, the main modality of management is usually surgical excision performed by a specialist surgeon. In tumours at higher risk of recurrence or metastasis pre- or post-operative radiotherapy should be considered. Systemic anti-cancer therapy (SACT) may be utilized in some cases where the histological subtype is considered more sensitive to systemic treatment. Regular follow-up is recommended to assess local control, development of metastatic disease, and any late-effects of treatment. For local recurrence, and more rarely in selected cases of metastatic disease, surgical resection would be considered. Treatment for metastases may include radiotherapy, or systemic therapy guided by the sarcoma subtype. In some cases, symptom control and palliative care support alone will be appropriate.

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“…Ultrasonography is the first‐line investigation of leiomyomas, and their abnormal appearance on ultrasound and increasing size or symptoms, particularly in patients who are postmenopausal or in the setting of medical therapy, require further investigation with magnetic resonance imaging (MRI) to exclude malignancy. The rate of leiomyosarcoma in leiomyomas previously considered benign is thought to be less than 1% 19 . Asymptomatic fibroids do not require treatment, and there are various approaches to manage symptomatic leiomyomas which will depend on the patient's preference; the patient's age and menopause status; the plans for fertility; location, size and number of leiomyomas; and available facilities.…”

Section: Leiomyomasmentioning

confidence: 99%

Abnormal uterine bleeding: managing endometrial dysfunction and leiomyomas

Brennan

Hickey

2018

Medical Journal of Australia

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Abnormal uterine bleeding refers to any change in the regularity, frequency, heaviness or length of menstruation. There are several potential causes for bleeding disturbance, the two most common being primary endometrial dysfunction and fibroids. Management of abnormal uterine bleeding involves both medical and surgical options and will largely depend on a patient's fertility plans. The use of levonorgestrel-releasing intrauterine devices for heavy menstrual bleeding is increasing in Australia, and they are considered first-line medical management for women accepting of hormonal therapies. Tranexamic acid, non-steroidal anti-inflammatory drugs, the combined oral contraceptive pill and oral progestins offer alternatives. Hysterectomy offers a definitive surgical approach to abnormal uterine bleeding and is associated with high levels of patient satisfaction. Women wishing to preserve their fertility, or avoid hysterectomy, may be offered myomectomy. Submucosal fibroids should be removed via hysteroscopy in symptomatic or infertile patients. Intramural and subserosal fibroids may be removed via an open or laparoscopic approach. There are several minimally invasive options, including uterine artery embolisation, magnetic resonance-guided focused ultrasound and endometrial ablation, but patients should be aware that there is insufficient evidence to ensure fertility preservation with these procedures and further research is needed. Areas for additional research include cost-effectiveness of treatments and quality of life comparisons between management options using patient reported outcome measures to evaluate patient satisfaction.

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Age-Stratified Risk of Unexpected Uterine Sarcoma Following Surgery for Presumed Benign Leiomyoma

Cited by 66 publications

References 14 publications

Clinical Characteristics and Prognosis of Unexpected Uterine Sarcoma After Hysterectomy for Presumed Myoma With and Without Transvaginal Scalpel Morcellation

Clinical Characteristics and Prognosis of Unexpected Uterine Sarcoma After Hysterectomy for Presumed Myoma With and Without Transvaginal Scalpel Morcellation

UK guidelines for the management of soft tissue sarcomas

Abnormal uterine bleeding: managing endometrial dysfunction and leiomyomas

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