Sarcoma

Question 0

How do you diagnose LMS? Stump?

Answer 0

Nuclear atypia, coagulative necrosis, mitosis greater than 15 /highpowered field
Stump: no atypia but necrosis with greater than 10 per high-powered field

Question 1

What is your surgical management for leiomyosarcoma? What is the recurrence rate

Answer 1

Hysterectomy and BSO postmenopausal. If premenopausal may omit BSO. No LAD due to 3 1/2% chance of lymph node involvement. Would only remove if enlarged nodes.
We currents rate is 40%ar

Question 2

How do you treat LMS? What is the response rate?

Answer 2

Gemzar 900 mg/m² day 1, 8
Taxotere 100mg/m2 squared day8
Response rate 54% other agents: Adriamycin 25%
IFos 17%
Adrienne plus iFos40%
Phase 2 trial, Hensley: stage 1-2: Gemzar/Taxotere x four, Adria x four PFS two year 78%

Question 3

Do you get chemotherapy for stage I LMS?

Answer 3

Yes, given that in early stage, the majority of occurrences are distal, I would give systemic chemotherapy. the recurrence rate is 40 to 50%, and 65% of those are distant

Question 4

What is the surgical management for ESS?

Answer 4

TAH BSO. I recommend removing the ovaries as these tumors are usually hormonally responsive

Question 5

Do you give adjuvant treatment after surgery for ESS?

Answer 5

Consider progestin Megace

Question 6

How do you treat high-grade ESS???

Answer 6

??

Question 7

How do you surgically manage carcinosarcoma?

Answer 7

TAH BSO, omentectomy, pelvic and para-aortic lymph node dissection. 50 have metastatic disease even in early stage. 17% have nodal dz(GOG 40)

Question 8

What adjuvant treatment do you give carcinosarcoma?

Answer 8

Holmesley in advanced or recurrent CS:GOG 161= improves OS with iFos vs iFos plus taxol(8.4 months versus 13.5 months
However there was a 30% chance of more neuropathy in the combination carbotaxol has a 52% response rate, awaiting results of clinical trial