Evaluation of lung metastases in patients with uterine leiomyosarcoma: assessing tumor volume doubling time
Type:Scientific Electronic Presentation
Authors: Raquel Alice Dias, Teresa Margarida Cunha
Keywords:uterine leiomyosarcoma; lung metastases; tumor volume doubling time

Uterine sarcomas comprise a minority of gynaecologic malignancies, among which leiomyosarcomas are the most represented entity. Tumour staging is performed according to the staging system defined by the International Federation of Gynaecology and Obstetrics (FIGO; please refer to Table 1); tumour stage at diagnosis is a crucial prognostic factor for patients with uterine leiomyosarcomas.

Complete surgical resection is the gold standard of treatment, but the overall prognosis of leiomyosarcomas is poor even when these lesions are diagnosed in an initial stage, leading to an overall 5-year survival of 15–25% (Abeler et al., 2009). On the other hand, when leiomyosarcomas confined to the uterus (stage I lesions) are completely resected, the benefit of adjuvant systemic therapy or radiotherapy on survival remains uncertain. In the absence of clear guidelines,...

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Table 1. FIGO staging guidelines for uterine leiomyosarcoma.

Material and methods

We performed a retrospective study in patients followed at our hospital with known metastatic uterine leiomyosarcoma. Patients under chemotherapy were excluded from the study, as were those with only one available thoracic evaluation or those with insufficient clinical data. Using the CT Lung Nodule Assessment application of the Intelispace software (see Fig. 1), lung lesion volumes were determined from two consecutive CT scans and the TVDT subsequently calculated, by applying the following equation: TVDT = (T2 -T1) × log2/logV2 – logV1, where T2−T1 corresponds to the time interval between the 2 evaluations; V1 and V2 represent the TVDT at these 2 points of evaluation (Nakamura et al., 2017). The delay between uterine leiomyosarcoma...

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Figure 1. Example of lung nodule volume calculation using the CT Lung Nodule Assessment (LNA) application. Target lesions were identified in vigilance CT scans (A). Subsequently, the LNA application was used to determine the lesion´s diameters (inset from A) and its volume was automatically calculated, as depicted in the output graph created by the application (B).

  1. A) TVDT calculation:

46 patients with uterine leiomyosarcoma were retrospectively reviewed. From this sample, 17 patients had metastatic lung disease. Within this subset of 17 patients, 5 were eligible for TVDT determination, with an average age at diagnosis of 65 years. An average TVDT of 325 days was determined, but there was a wide variability between individual TVDT values, varying from 18 to 1122 days. Because of the small sample size, it is unclear whether this variability results from including an outlier TVDT value or rather, if it reflects a real discrepancy in the behaviour of metastatic disease across patients such as has been reported before for bone and soft-tissue sarcoma (Nakamura et al., 2017) – which could then justify the use of tailored treatment options. These data are illustrated in Table...

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Table 2. Individual patient data. Aside from patient age, the remaining values are given in days. Abbreviations: Pt., patient; M1, metastatic lung disease; y, years of age.


Uterine sarcomas comprise a heterogeneous group of gynaecologic malignancies, among which leiomyosarcoma accounts for the most frequent entity. Stage at diagnosis represents the single most important prognostic factor, but even tumours confined to the uterus at the time of diagnosis have been shown to associate with poor prognosis (Abeler et al., 2009; D’Angelo et al., 2009). Furthermore, because these are rare tumours, there is still a lack of consensus on optimal treatment strategies. When metastatic lung disease is diagnosed, metastasectomy may afford significant prolongation of patient survival, but even after complete metastasis resection, 40 to 80 % of patients will show disease recurrence (Weiser et al., 2000; Nakamura et al., 2011). It is thus essential to choose which patients take the most advantage of this treatment option, by understanding metastatic disease...

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