Connective Tissue Oncology Society

2001 CTOS Annual Meeting Posters— Surgery

SURGICAL RESECTION, VASCULAR RECONSTRUCTION, AND POSTOPERATIVE RADIATION FOR LEIOMYOSARCOMA OF THE INFERIOR VENA CAVA
Fritz Christian Eilber, Gerald Rosen, Michael Selch, Scott Nelson, William Quinones, Frederick Richard Eilber
Divisions of Surgical Oncology, Medical Oncology, Radiation Oncology, Surgical Pathology and Vascular Surgery, University of California Los Angeles

OBJECTIVE: Surgical resection for leiomyosarcoma of the inferior vena cava has been minimally effective due to the technical difficulties of surgery, postoperative morbidity, and poor overall survival. The purpose of this study was to determine if aggressive multimodality therapy for leiomyosarcoma of the inferior vena cava would provide survival rates comparable to non-vena caval leiomyosarcomas of the retroperitoneum.

METHODS: From 1983 to 2000 22 patients with primary leiomyosarcoma of the inferior vena cava were evaluated for multimodality treatment consisting of complete surgical resection, immediate vascular reconstruction of the inferior vena cava and postoperative radiation therapy. Treatment results were reviewed and compared to 41 patients with non-vena caval leiomyosaromas of the retroperitoneum treated at the same institution.

RESULTS: Nineteen patients (19/22, 86%) successfully underwent complete surgical resection with vascular reconstruction of the vena cava. The remaining three (3/22, 14%) patients were unresectable due to aorto-mesenteric involvement and died of their disease within 14 months of evaluation. Seventeen of the 19 resectable patients (17/19, 89%) received postoperative radiation and two patients (2/19, 11%) did not. Local tumor control was achieved in 16 of the 17 patients (16/17, 94%) who received postoperative radiation but in neither of the two patients that did not. With a mean follow up of 52 months, the overall survival for the 19 resectable patents was 82% at one year, 53% at three years and 44% at five years. These results are comparable to the 85 % one year, 62% three year and 40% five year survival rate for the 41 patients with non-vena caval leiomyosaroma of the retroperitoneum treated at the same institution.

CONCLUSION: Complete surgical resection with immediate vascular reconstruction for leiomyosarcoma of the inferior vena cava was achievable in 86% of the cases. This aggressive surgical approach combined with postoperative radiation therapy can provide survival rates similar to non-vena caval leiomyosarcomas of the retroperitoneum and thus provides a successful treatment strategy for a rarely treated malignancy.