Sphincter preservation of leiomyosarcoma of the rectum and anus with localexcision and brachytherapy

PURPOSE: The aim of this study was to determine the outcome of patients wit h leiomyosarcoma of the rectum or anus treated with local excision and brac hytherapy. METHODS: Eight patients with leiomyosarcoma of the rectum (7 pat ients) or anus (1 patient) were treated with a transanal excision followed by a temporary iridium-192 interstitial implant to 4,500 cGy. Median tumor size was 4.2 (range, 1.5-5) cm. Margins were positive in six patients, nega tive in one patient, and close in one patient. RESULTS: With a median follo w-up of 53 months, median survival time was 53 months and the three-year ac tuarial survival rate was 71 percent. The cumulative incidence of failure a s a component of failure for local was 25 percent (2/8), for abdominal was 0 percent (0/8), and for distant was 25 percent (2/8). Four patients eligib le for functional analysis all had excellent sphincter function (1-2 bowel movements per day, no soilage). CONCLUSION: In selected patients the use of conservative surgery followed by brachytherapy is a reasonable alternative to an abdominoperineal resection. However, more experience and longer foll ow-up are needed before this approach can be recommended routinely.