Brian Van Tine, MD, PhD:So, our next case is a 61-year-old Caucasian female with an 11 cm primary uterine leiomyosarcoma that’s, unfortunately, spread to her peritoneum. It has actually already spread all the way to her lungs. Unfortunately, her ECOG performance status was 1.
There are a number of risk factors that can occur to a patient like this. The most common place for any sarcoma to spread is most likely the lungs. But, I think the uterine leiomyosarcoma patients have a unique niche. First, a lot of them have been morcellated. What that does is actually spread the tumor all around the abdomen, and that’s a practice that probably should be avoided. But, once you’ve spread it around the abdomen, these patients end up as stage IV. Through the eyes of a sarcoma doctor, they’re not curable. The natural history of this tumor, if it gets up and spreads, shows up in the lung. A lot of patients can potentially put off their abnormal uterine bleeding, or think they have horrible fibroids and just let these things get out of control. And so, I think it’s always important that you maintain your adequate OBGYN visits lifelong.
The prognosis for a patient like this, and I think our approach for a patient like this, is to extend their life. Somebody who has both peritoneal and lung metastases would not be curable by any standard that we have available today. I think we’re looking at the use of either palliative chemotherapy or hospice as an approach.
Case Scenario 2: