RESULTS OF AGGRESSIVE TREATMENT OF GASTRIC SARCOMA

Background: Leiomyosarcoma and leiomyoblastoma are subtypes of gastric smooth muscle tumors. These rare tumors are usually treated with surg ical resection. However, there is controversy regarding the optimal su rgical management for these malignancies and little information is ava ilable on the efficacy of radiation and chemotherapy in the adjuvant o r palliative setting. Methods: The records of 32 patients with gastric leiomyosarcoma or leiomyoblastoma were reviewed. Survival data were o btained and patient outcome was analyzed with respect to the type of t reatment given. Four different staging systems were compared for their ability to predict survival. Results: Thirty patients with leiomyosar coma and two patients with leiomyoblastoma were followed after surgery . All 32 patients were explored, and 21 curative and 11 palliative pro cedures were performed. Adjacent organs were included in 38% of resect ions. Only three patients did not undergo gastric resection. Local rec urrence developed in eight patients after curative resection for a loc al control rate of 62%. Eight other patients developed metastatic dise ase for an overall recurrence rate of 76% after curative resection. Me dian survival of patients undergoing curative resection was 40 months compared with 8 months for those having a palliative procedure. The es timated 5-year survival was 34% and 10%, respectively (p = 0.05). Twen ty-five patients with advanced disease received systemic, hepatic arte rial, or intraperitoneal chemotherapy. Eighty percent of patients rece ived a regimen including doxorubicin. Four partial and one complete re sponse were noted. Seven patients received postoperative radiation the rapy. Fourteen patients underwent debulking surgery of recurrent or pe rsistent disease in conjunction with chemotherapy. Chemotherapy, radia tion therapy, and debulking surgery did not result in statistically si gnificant prolongation of survival. Seven patients remain alive, two w ith liver metastases. Four different staging systems for gastric sarco mas were compared, but none of them were found to be clearly superior in predicting survival. Conclusions: Curative gastric resection was ac hieved in 66% of patients and resulted in a significant prolongation o f survival as compared with patients who had a palliative procedure. W edge resection of tumor or partial gastric resection appears to be an acceptable surgical approach to these tumors as long as negative margi ns can be obtained. Chemotherapy, radiation therapy and debulking surg ery did not result in significant prolongation of survival in the face of advanced disease. None of the staging systems for gastric sarcoma currently in use is completely satisfactory. Tumor grade and extent of disease seem to be the most important factors when determining progno sis or considering adjuvant therapy.