Combined CRS With HIPEC in Women With Inadvertently Morcellated uLMS
Combined Cytoreductive Surgery With Hyperthermic Intraperitoneal Chemotherapy in Women With Inadvertently Morcellated Uterine Leiomyosarcoma: a Registry Study From a Tertiary Referral Hospital
Study Overview
Detailed Description
For patients undergoing hysterectomy or myomectomy for benign uterine tumors, minimally invasive gynecologic surgery (MIGS) has the advantages of fewer complications and faster recovery time compared with traditional laparotomy. Morcellation techniques, which are used to pulverize the uterus or myoma, facilitate the implementation of MIGS, especially for women with large uteruses or myomas or who are nulliparous. However, the safety of morcellation techniques has been controversial since the US Food and Drug Administration (FDA) issued a warning in 2014. The main concern is that unprotected morcellation may spread tissue fragments throughout the abdominal cavity. If a malignancy is present, such as uterine leiomyosarcoma (uLMS)-a highly invasive tumor that is difficult to diagnose preoperatively-this spread can have catastrophic consequences. The 5-year disease-specific survival rate for patients with uLMS who undergo unprotected morcellation is only 25.3%, while the 5-year disease-specific survival rate for patients who undergo complete tumor resection is 62.6%. Although the FDA recommends the use of tissue containment systems during laparoscopic morcellation, implementation of this recommendation varies worldwide, and endobag devices (tissue protection bags) are not universally available. Therefore, the management of peritoneal uLMS that disseminate after unprotected morcellation remains a major clinical challenge.
Hyperthermic intraperitoneal chemotherapy (HIPEC) is an important method for the treatment of peritoneal disseminated tumors. Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) has shown efficacy in the treatment of peritoneal carcinomatosis in gastrointestinal and ovarian cancers. Recent studies have reported that it can significantly improve progression-free survival (PFS) and overall survival (OS) rates in patients with recurrent uLMS with peritoneal metastasis. A meta-analysis of 13 cases of recurrent uLMS conducted by Matsuzaki et al. in 2021 showed that the 3-year progression-free survival (PFS) and overall survival (OS) rates of patients who received CRS-HIPEC were 71.4% and 75.0%, respectively, compared with 0% and 50.1% for patients who received CRS alone. However, the efficacy and safety of this treatment for patients with accidentally comminuted uLMS remain uncertain.
In 2016, Sun Yat-sen Memorial Hospital of Sun Yat-sen University established a HIPEC program to routinely perform tumor reduction surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) for patients with comminuted uLMS. Due to the limited availability of the HIPEC program outside our center, the HIPEC PROGRAM registry system was established to help refer patients from external institutions and receive CRS-HIPEC treatment. This study will conduct a retrospective study through the registration system, with patients who underwent unprotected morcellation surgery for occult uLMS and received CRS-HIPEC treatment as the research subjects, with progression-free survival (PFS) and overall survival (OS) as the primary outcomes, and the incidence of HIPEC-related ≥ grade 3 adverse events (AEs) as the secondary outcome, to evaluate the efficacy and safety of CRS-HIPEC as the first-line treatment for accidentally morcellated uLMS.
Study Type
Enrollment (Actual)
Contacts and Locations
Study Locations
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Guangdong
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Guangzhou, Guangdong, China, 510120
- Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
- Child
- Adult
- Older Adult
Accepts Healthy Volunteers
Sampling Method
Study Population
Description
Inclusion Criteria:
- Patients who underwent myomectomy or hysterectomy for presumed benign disease and used non-protected morcellation and were subsequently pathologically diagnosed with uterine leiomyosarcoma.
- Patients underwent open laparotomy with similar surgical principles to epithelial ovarian cancer and achieved complete resection (R0 resection)
- Patients received closed hyperthermic intraperitoneal chemotherapy with docetaxel + gemcitabine after surgery.
Exclusion Criteria:
- Patients who received chemotherapy or radiotherapy previously.
- Incomplete follow-up data
Study Plan
How is the study designed?
Design Details
Cohorts and Interventions
Group / Cohort |
Intervention / Treatment |
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CRS-HIPEC
The patient received open laparotomy cytoreduction surgery in the same principle as epithelial ovarian cancer surgery, and received intraperitoneal hyperthermic chemotherapy with docetaxel (75 mg/m²) and gemcitabine (1000 mg/m²) within 24 hours after surgery.
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Patients with uterine leiomyosarcoma who received unprotected morcellation were treated with cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy with docetaxel and gemcitabine.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
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Progression Free Survival (PFS)
Time Frame: From completion of CRS-HIPEC to disease recurrence, assessed up to 120 months
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Time from completion of CRS-HIPEC to disease recurrence
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From completion of CRS-HIPEC to disease recurrence, assessed up to 120 months
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Overall survival (OS)
Time Frame: From completion of CRS-HIPEC to death of any cause, assessed up to 120 months
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Time from completion of CRS-HIPEC to death of any cause
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From completion of CRS-HIPEC to death of any cause, assessed up to 120 months
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
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Adverse Events (AE)
Time Frame: up to 3 weeks after CRS-HIPEC
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he adverse events would be graded according to Memorial Sloan-Kettering Cancer Center surgical secondary events (MSK SSE) grading system.
The types and incidence of AEs will be recorded to evaluate the safety of CRS-HIPEC
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up to 3 weeks after CRS-HIPEC
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Collaborators and Investigators
Publications and helpful links
General Publications
- Matsuzaki S, Matsuzaki S, Chang EJ, Yasukawa M, Roman LD, Matsuo K. Surgical and oncologic outcomes of hyperthermic intraperitoneal chemotherapy for uterine leiomyosarcoma: A systematic review of literature. Gynecol Oncol. 2021 Apr;161(1):70-77. doi: 10.1016/j.ygyno.2020.12.032. Epub 2021 Jan 6.
- Xu X, Lin H, Wright JD, Gross CP, Boscoe FP, Hutchison LM, Schwartz PE, Desai VB. Association Between Power Morcellation and Mortality in Women With Unexpected Uterine Cancer Undergoing Hysterectomy or Myomectomy. J Clin Oncol. 2019 Dec 10;37(35):3412-3424. doi: 10.1200/JCO.19.00562. Epub 2019 Sep 16.
- Graebe K, Garcia-Soto A, Aziz M, Valarezo V, Heller PB, Tchabo N, Tobias DH, Salamon C, Ramieri J, Dise C, Slomovitz BM. Incidental power morcellation of malignancy: a retrospective cohort study. Gynecol Oncol. 2015 Feb;136(2):274-7. doi: 10.1016/j.ygyno.2014.11.018. Epub 2014 Nov 26.
- Senapati S, Tu FF, Magrina JF. Power morcellators: a review of current practice and assessment of risk. Am J Obstet Gynecol. 2015 Jan;212(1):18-23. doi: 10.1016/j.ajog.2014.07.046. Epub 2014 Jul 26.
- Rayburn WF. Minimally Invasive Gynecologic Surgery: Improving Outcomes and Recovery While Reducing Discomfort and Cost. Obstet Gynecol Clin North Am. 2022 Jun;49(2):xiii-xiv. doi: 10.1016/j.ogc.2022.04.002. No abstract available.
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimated)
Study Record Updates
Last Update Posted (Estimated)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- SYSKY-2024-939-01
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
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