000			03155nam a22003857a 4500
008			221213s20212021 xxu||||| |||| 00| 0 eng d
022			_a2352-5789
024			_a10.1016/j.gore.2021.100741 [doi]
024			_aPMC7970133 [pmc]
024			_aS2352-5789(21)00046-1 [pii]
040			_aOvid MEDLINE(R)
099			_a33748383
245			_aLong-term outcomes after cytoreductive surgery and HIPEC for morcellated uterine leiomyosarcoma; A case series.
251			_aGynecologic Oncology Reports. 36:100741, 2021 May.
252			_aGynecol Oncol Rep. 36:100741, 2021 May.
253			_aGynecologic oncology reports
260			_c2021
260			_fFY2021
260			_p2021 May
265			_sepublish
265			_tPubMed-not-MEDLINE
266			_d2022-12-13
520			_aUterine leiomyosarcoma (uLMS) is a rare aggressive malignant mesenchymal tumor with high risk of recurrence and poor prognosis regardless of stage. It is often diagnosed postoperatively following myomectomy, hysterectomy or supracervical hysterectomy for presumed benign disease. Primary surgery at the diagnosis of uLMS is considered to affect outcomes. If the tumor was morcellated, the oncologist will encounter special problems that require knowledgeable management of peritoneal metastases. We previously reported that six patients who successfully underwent cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) plus early postoperative intraperitoneal chemotherapy (EPIC) to manage the disease dissemination that must occur following morcellation. This is a study for long-term outcome of these patients. Six patients were treated with an absence of grade IV adverse events and no mortality. The median Peritoneal Cancer Index (PCI) was 18 and complete cytoreduction without peritoneal metastases visualized within the operative field at the completion of the surgical procedure (CC-0) was achieved in all patients. One patient was diagnosed leiomyomatosis peritonealis postoperatively. Among five patients who were confirmed uterine leiomyosarcoma, the 3-year overall survival was 40.0% and 5-year overall survival was 20.0% with the median follow-up of 18 months (range 5-73 months). The patient with PCI 0 at the time of CRS showed no evidence of disease (NED) at 73 months. We believe that prophylactic CRS contributed her favorable outcome. Therapeutic options for patients with uLMS post-morcellation are limited. Currently, CRS and HIPEC plus EPIC followed by adjuvant systemic chemotherapy may be considered an option for treatment. Further studies in a larger number of patients are needed. Copyright © 2021 The Authors. Published by Elsevier Inc.
546			_aEnglish
651			_aMedStar Washington Hospital Center
651			_aWashington Cancer Institute
656			_aObstetrics and Gynecology
657			_aJournal Article
700			_aDainty, Louis A
700			_aSugarbaker, Paul H
700			_aYasukawa, Maya
790			_aDainty LA, Sugarbaker PH, Yasukawa M
856			_uhttps://dx.doi.org/10.1016/j.gore.2021.100741 _zhttps://dx.doi.org/10.1016/j.gore.2021.100741
942			_cART _dArticle
999			_c18 _d18