GASTRIC LEIOMYOSARCOMA - CLINICAL, MORPHO LOGICAL AND THERAPEUTIC RESULTS

Background: Due to the rarity of gastric leiomyosarcomas, only little is known on the results of diagnostics and therapy of these tumors. Ac cording to literature, the problem of suitable criteria in determining malignancy of these neoplasms is unsettled. Patients and Method: 21 p atients (10 male, 11 female, aged 13 to 74 [53 +/- 13,9] years) with l eiomyosarcomas of the stomach were treated from 1978 to 1993. In a ret rospective study, the diagnostic and therapeutic results and the patho logic features of these patients are compared with the results of lite rature.Results: Diagnosis was rarely confined preoperatively. Potentia lly curative resection was possible in 13/21 cases. Five year survival was 44% overall (RD-resections: 60%, R1/2-resections 22%) with a wide spread of individual cases. Pathologic examination of the tumors show ed only half of the tumors classifiable according to the system of McG rath. Some well differentiated tumors revealed unclear malignancy crit eria. Analysis of prognostic factors showed no statistically significa nt influence of surgical radicality but a significant influence of tum or size, mitotic activity and nuclear grading on survival and recurren ce. Conclusion: Because of their rare incidence, the treatment of gast ric leiomyosarcomas remains non-standardized. Surgical radical removal of the tumor seems to promise the largest benefit. The treatment of p atients with a residual or recurrent tumors remains individual, no adj uvant radio- or chemotherapeutical treatment can be generally recommen ded.