SESSION TYPE: Cancer Student/Resident Case Report Posters
PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM
INTRODUCTION: Leiomyosarcoma is a rare malignancy which responds poorly to systemic chemotherapy and radiation. Dew, et al. demonstrated a 5 year survival rate of 31% after surgical resection of the primary tumor. We present a 48 yo patient with leiomyosarcoma metastases to the lung treated with transpulmonary chemoembolization (TPCE).
CASE PRESENTATION: A 48 year old man presented with lower extremity edema and was diagnosed with leiomyosarcoma of the IVC. After surgical resection of the primary tumor and systemic chemotherapy and radiation, the patient developed lung and liver metastasis not amenable to surgical resection. His liver metastases are well controlled with transarterial chemoembolization. His lung metastases continue to progress despite systemic chemotherapy. He has undergone two treatments of segmental TPCE using doxorubicin beads (image 1). He had minimal fatigue the week after the second procedure. He had no other systemic side effects such as nausea, vomitting, or mucositis. He has no worsening cough or chest pain related to embolization of the pulmonary artery. Image 2 demonsrates post-procedural appearance of his left lung. He will undergo further TPCE for continued treatment.
DISCUSSION: Leiomyosarcoma of the IVC is a rare malignancy with less than 300 cases reported. Our patient in this study has disease recurrence to the lungs and liver after primary surgical resection and systemic chemotherapy administration. Given the poor response of leiomyosarcoma to chemotherapy and radiation, alternate therapies were considered to treat his nonresectable pulmonary disease. Vogl, et al. performed a study from 2001-2005 demonstrating the use of TPCE for pulmonary metastatic disease in 52 patients. 27 of the 52 cases demonstrated partial response or stable disease and all patients had minimal side effects from the procedure. Our patient has undergone 2 treatments of TPCE for his pulmonary disease. The patient has experienced no significant side effects from the embolization or local chemotherapy administration; he has had no complications since his initial treatment approximately 45 days ago.
CONCLUSIONS: TPCE is a promising treatment option for patients with unresectable pulmonary metastatic disease. Our patient has had no significant complications or side effects after treatment. Although no conclusions can be drawn on one case, the lack of significant side effects after local doxorubicin administration suggests that further research is warranted using TPCE as a tolerable treatment for nonresectable pulmonary metastatic disease.
1) J. Dew, K. Hansen, J. Hammon, T. McCoy, E. A. Levine, and P. Shen, “Leiomyosarcoma of the inferior vena cava: surgical management and clinical results,” American Surgeon, vol. 71, no. 6, pp. 497-501, 2005.
2) Vogl TJ, Lehnert T, Zangos S, Eichler K, Hammerstingl R, Korkusuz H, Lindemayr S. Transpulmonary chemoembolization (TPCE) as a treatment for unresectable lung metastases. Eur Radiol. 2008;18:2449-2455.
DISCLOSURE: The following authors have nothing to disclose: Andrew West, Drew Sessions, Mollie Meek
Transpulmonary Chemoembolization of pulmonary metastases is a procedure that has been rarely reported in literature. It is still likely considered a research procedure/technique. This will not discuss any products used.UAMS, Little Rock, AR