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IMPACT OF TUMOR MORCELLATION ON THE NATURAL HISTORY OF UTERINE LEIOMYOSARCOMA

IMPACT OF TUMOR MORCELLATION ON THE NATURAL HISTORY OF UTERINE LEIOMYOSARCOMA. César Serrano, Titilope Oduyebo , Judith Manola , Yang Feng , Michael G. Muto, Suzanne George Dana-Farber Cancer Institute , Brigham and Women’s Hospital; Harvard Medical School, Boston, USA.

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IMPACT OF TUMOR MORCELLATION ON THE NATURAL HISTORY OF UTERINE LEIOMYOSARCOMA

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  1. IMPACT OF TUMOR MORCELLATION ON THE NATURAL HISTORY OF UTERINE LEIOMYOSARCOMA César Serrano, TitilopeOduyebo, Judith Manola, Yang Feng, Michael G. Muto, Suzanne George Dana-Farber Cancer Institute , Brigham and Women’s Hospital; Harvard Medical School, Boston, USA CTOS 18th Annual Meeting Oct 30- Nov 2, 2013 New York Paper 011

  2. Background • Uterine leiomyosarcoma (ULMS) accounts for about 1.5% of all uterine malignancies and 30% of uterine sarcomas. • Complete surgical excision is the only established curative treatment modality for localized disease. • Minimally invasive techniques are increasingly used in the surgical treatment of uterine leiomyoma. • No specific symptoms/signs or diagnostic imaging can reliably differentiate ULMS from leiomyoma preoperatively. Because of this, inadvertent morcellation of ULMS is increasingly seen in clinical practice.

  3. Background (con’t) • Historically, ~50% of localized ULMS recurs following resection. • Lungs are the most common site of recurrence. Pautier P, et al. 2000 Major FJ, et al. 1993 Kapp DS, et al. 2008

  4. Uterine morcellation • Tumor morcellation involves fragmenting of lesions in the abdominal cavity such that they can pass through the laparoscopic ports. • Tumor morcellation has been associated with dispersal of microscopic tumor fragments, which entails potential seeding in the peritoneum. • One retrospective study observed that tumor morcellation is an adverse prognosis factor associated with shorter disease-free survival and overall survival. Seidman MA et al. 2012 Park JY et al. 2011

  5. Aims of the study To retrospectively assess the impact of tumor morcellation on the natural history and outcomes of patients with ULMS when compared to patients who underwent total abdominal hysterectomy (TAH) as the primary procedure.

  6. Methods • Patients with ULMS seen at Dana-Farber Cancer Institute and Brigham and Woman’s Hospital from 2007-2012 were reviewed. • Patients with surgically resectable disease confined to the uterus at presentation and adequate follow-up were included. • Morcellationcohort included only those cases with intra-peritoneal morcellation • Cases which underwent morcellationin a bag intra-operatively were excluded • TAHcohortincluded cases who underwent complete hysterectomy without tumor disruption.

  7. Patients characteristics (n=68)

  8. Patients characteristics (n=68)

  9. Patients characteristics (con’t)

  10. Morcellation is associated with a significantly increased rate of LMS recurrence Whenadjustingfordifferences in follow-up betweenthetwocohorts, theincidencerate of recurrenceamongptswhounderwentmorcellationis more thantwo times therate of thosewhohad tumor removed byTAH.

  11. Tumor morcellation led to a decrease in Recurrence Free Survival (RFS) p-value = 0.034 Median RFS TAH = 25.7 months Median RFS Morcellation = 10.8 months

  12. Higher incidence of peritoneal recurrence after tumor morcellation

  13. Tumor morcellation is an independent risk factor for recurrence We investigated the relationship between each covariant and RFS. Only morcellation, size and mitosis were found significant in the statistical model.

  14. Conclusions • Uterine morcellation of presumed leiomyomas inadvertentlyresult in an increase in morcellated ULMS. • Morcellation alters the natural course of ULMS leading to an increased incidence and earlier recurrences. • Recurrences following tumor morcellation are significantly more likely to occur in the peritoneum. • Additional studies are needed to identify patients at high risk for ULMS prior to presumed leiomyoma resection in order to reduce the risk of inadvertent tumor morcellation.

  15. Co-authors / Acknowledgments Brigham and Women’s Hospital Dana-Farber Cancer Institute Pathology Department Christopher P. Crum Marisa R. Nucci Division of Obstetrics and Gynecology Michael M. Muto TitilopeOduyebo Center for Sarcoma and Bone Oncology George D. Demetri James E. Butrynski David R. D’Adamo Suzanne George Jeffrey A. Morgan Andrew J. Wagner Department of Biostatistics and Computational Biology ConstanceBarysauskas Yang Feng Judith Manola ASCO Young Investigator Award Spanish Society of Medical Oncology Translational Award Driscoll Family Leiomyosarcoma Fund

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