Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for sarcomatosis from uterine adenosarcoma
Keywords:Cytoreduction, Hyperthermic intraperitoneal chemotherapy, Uterine sarcoma
Uterine adenosarcoma has poor prognosis and management of this disease is controversial. We describe a case of sarcomatosis secondary to recurrent uterine adenosarcoma who underwent cytoreductive surgery (CS) and hyperthermic intraoperative peritoneal chemotherapy (HIPEC). A 52 year-old female presented with perimenopausal menometrorrhagia. She underwent laparoscopic hysterectomy and bilateral salpingo-oopherectomy with pathology showing uterine adenosarcoma. She developed a pelvic recurrence 2 years later. A pelvic exenteration was then performed and within 8 months, she recurred. CS/HIPEC with Cisplatin was performed. Six weeks post-operatively, the patient was found to have recurrence again. This case describes the use of CS/HIPEC as a treatment modality for uterine adenosarcoma with sarcomatosis. Despite CS and HIPEC, the patient developed an aggressive recurrence within six weeks of her surgery date. We recommend a multidisciplinary approach to this disease with the recognition that CS/HIPEC may offer little benefit as a salvage therapy based on this case.
D’Angelo E, Prat J. Uterine sarcomas: a review. Gynecol Oncol. 2010;116:131-9.
Major FJ, Blessing JA, Silverberg SG, Morrow CP, Creasman WT, Currie JL et al. Prognostic factors in early-stage uterine sarcoma. A Gynecologic Oncology Group study. Cancer. 1993;71:1702-9.
Carroll A, Ramirez PT, Westin SN, Soliman PT, Munsell MF, Nick AM et al. Uterine adenosarcoma: an analysis on management, outcomes, and risk factors for recurrence. Gynecol Oncol. 2014;135:455-61.
Giuntoli RL, Metzinger DS, DiMarco CS, Cha SS, Sloan JA, Keeney GL et al. Retrospective review of 208 patients with leiomyosarcoma of the uterus: prognostic indicators, surgical management, and adjuvant therapy. Gynecol Oncol. 2003;89:460-9.
Abeler VM, Røyne O, Thoresen S, Danielsen HE, Nesland JM, Kristensen GB. Uterine sarcomas in Norway. A histopathological and prognostic survey of a total population from 1970 to 2000 including 419 patients. Histopathol. 2009;54:355-64.
Spiliotis J, Halkia E, Lianos E, Kalantzi N, Grivas A, Efstathiou E et al. Cytoreductive surgery and HIPEC in recurrent epithelial ovarian cancer: a prospective randomized phase III study. Ann Surg Oncol. 2015;22:1570-5.
Jimenez WA, Sardi A, Nieroda C, Gushchin V. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the management of recurrent high-grade uterine sarcoma with peritoneal dissemination. Am J Obstet Gynecol. 2014;210:259.e1-8.
Prat J. FIGO staging for uterine sarcomas. Int J Gynaecol Obstet Off Organ Int Fed Gynaecol Obstet. 2009;104:177-8.
Clement PB, Scully RE. Mullerian adenosarcoma of the uterus: a clinicopathologic analysis of 100 cases with a review of the literature. Hum Pathol. 1990;21:363-81.
Friedlander ML, Covens A, Glasspool RM, Hilpert F, Kristensen G, Kwon S et al. Gynecologic Cancer InterGroup (GCIG) consensus review for mullerian adenosarcoma of the female genital tract. Int J Gynecol Cancer Off J Int Gynecol Cancer Soc. 2014;24:S78-82.
Zaloudek CJ, Norris HJ. Adenofibroma and adenosarcoma of the uterus: a clinicopathologic study of 35 cases. Cancer. 1981;48:354-66.
Krivak TC, Seidman JD, McBroom JW, MacKoul PJ, Aye LM, Rose GS. Uterine adenosarcoma with sarcomatous overgrowth versus uterine carcinosarcoma: comparison of treatment and survival. Gynecol Oncol. 2001;83:89-94.
National Comprehensive Cancer Network. Uterine Neoplasms Version 2.2016. www.nccn.org. Accessed Feb 2016.
Tanner EJ, Toussaint T, Leitao MM, Hensley ML, Soslow RA, Gardner GJ et al. Management of uterine adenosarcomas with and without sarcomatous overgrowth. Gynecol Oncol. 2013;129:140-4.
Baratti D, Pennacchioli E, Kusamura S, Fiore M, Balestra MR, Colombo C et al. Peritoneal sarcomatosis: is there a subset of patients who may benefit from cytoreductive surgery and hyperthermic intraperitoneal chemotherapy? Ann Surg Oncol. 2010;17:3220-8.