Impact of Chemotherapy in the Adjuvant Setting of Early Stage Uterine Leiomyosarcoma: A Systematic Review and Updated Meta-Analysis

Abstract

Background: Although the use of adjuvant chemotherapy (AC) appears to be increasing over the past few years, several clinical trials and previous meta-analyses failed to determine whether AC could improve clinical outcomes in uterine leiomyosarcoma (uLMS). The aim of this systematic review and meta-analysis was to compare AC (with or without radiotherapy) versus observation (obs) after primary surgery in early stage uLMS. Materials and Methods: Randomized controlled (RCTs) and non-randomized studies (NRSs) were retrieved. Outcomes of interest were as follows: distant recurrence rate, locoregional recurrence rate and overall recurrence rate. Results about distant recurrence rate, locoregional recurrence rate and overall recurrence rate were compared by calculating odds ratios (ORs) with 95% confidence intervals (CIs); ORs were combined with Mantel–Haenszel method. Results: Nine studies were included in the analysis, involving 545 patients (AC: 252, obs: 293). Compared with obs, AC did not reduce locoregional and distant recurrence rate, with a pooled OR of 1.36 and 0.63, respectively. Similarly, administration of AC did not decrease overall recurrence rate in comparison to obs. Conclusion: According to our results, AC (with or without radiotherapy) did not decrease recurrence rate in early stage uLMS; thus, the role of AC in this setting remains unclear.

Safety and effectiveness of gemcitabine for the treatment of classic Kaposi’s sarcoma without visceral involvement

“…Notably, gemcitabine is particularly active in sarcomas of vascular origin, representing a therapeutic option for the histology-driven treatment of angiosarcoma, epithelioid hemangioendothelioma, and intimal sarcoma. 22 – 25 , 37 Furthermore, we knew that gemcitabine does not have dose-limiting toxicity. Thus, in a neoplasm with an indolent course, with a long life expectancy, this element represents a great advantage.…”

Uterine Preservation Treatments in Sarcomas: Oncological Problems and Reproductive Results: A Systematic Review

“…Sarcomas are a very heterogeneous class of diseases and can therefore be analyzed by histotype, stage, grade and growth profile; the results of FST and standard treatments could be considered, although this type of analysis requires a large series of patients, which is currently not available. Moreover, the role of postoperative treatment in uterine sarcomas is still debated, and current decision-making varies by histological subtype and other pathological and clinical features, in a case-by-case fashion [ 5 ]. Finally, the choice of a conservative surgery should take into account the biological background of uterine sarcomas, considering that the pathogenetic role of estrogen varies among different histotypes.…”

“…Leiomyosarcoma (LMS) represent the more aggressive among the group, and despite radical surgery, the risk of recurrence remains high, ranging between 50% and 70%. The high recurrence rate of LMS provides the rationale for postoperative treatment; neither adjuvant cytotoxic chemotherapy nor adjuvant radiotherapy have been shown to reduce the risk of relapse in early stages [ 5 ].…”

Evaluation of Hedgehog Pathway Inhibitors as a Therapeutic Option for Uterine Leiomyosarcoma Using the Xenograft Model

“…It is a rare and aggressive gynecological cancer, which accounts for 1% of all uterine malignancies. LMS is challenging to treatment exhibiting resistance to several therapies including FDAapproved drugs such as pazopanib and olaratumab [2,[5][6][7][8], evidenced by high rates of recurrence and progression [9,10]. These characteristics emphasize the need for new therapeutic options for this tumor.…”