Bone and soft tissue sarcomas, tumors of the skinBone and soft tissue sarcomas, tumors of the skinСаркомы костей, мягких тканей и опухоли кожи2219-46142782-3687Publishing House ABV Press485SOFT TISSUE SARCOMASСАРКОМЫ МЯГКИХ ТКАНЕЙTreatment of uterine leiomyosarcomaЛечение лейомиосарком маткиFedenkoA. A.ФеденкоА. А.
Russian Federation

Moscow

г. Москва

fedenko@eesg.ruKonevA. A.КоневА. А.
Russian Federation

Moscow

г. Москва

GorbunovaV. A.ГорбуноваВ. А.
Russian Federation

Moscow

г. Москва

FGBU N.N. Blokhin Russian Cancer Research CenterФГБУ Российский онкологический научный центр им. Н.Н. Блохина РАМН270120146156632701202227012022Copyright ©; 2014, Fedenko A.A., Konev A.A., Gorbunova V.A.Copyright ©; 2014, Феденко А.А., Конев А.А., Горбунова В.А.2014Fedenko A.A., Konev A.A., Gorbunova V.A.Феденко А.А., Конев А.А., Горбунова В.А.https://creativecommons.org/licenses/by/4.0https://sarbon.abvpress.ru/jour/article/view/485

This article is a review of uterine leiomyosarcomas treatment options. Based on the data from different trials we recommend the following treatment strategy. Surgery: total hysterectomy must be done in localized disease, further adjuvant chemotherapy is possible, but the decision should be taken individually. Adjuvant radiation therapy is not recommended due to low influence on overall survival. Advanced uterine leiomyosarcomas should be treated by combined chemotherapy. As a first line we recommend combined regimens including doxorubicin, dacarbazine, ifosfamide and gemcitabine, docetaxel. Trabectedin monotherapy as a 24-hour infusion showed good result in long-term SD and can be used as a second or further lines of treatment. Hormone therapy is possible as supportive treatment if status of steroid hormone receptors in the tumor is positive. The decision on second look surgery in advanced disease should be discussed individually. Also our data of trabectedin use in pts with uterine leiomyosarcomas is fully discussed. We got the same treatment and toxicity results as in STS-201. After the dose reduction till 1,3 mg/m2 we got more favorable toxicity profile with the same efficacy but further investigation is needed.

Данная статья посвящена обзору лечения лейомиосарком матки. На основании данных различных исследований мы рекомендуем проводить следующие этапы лечения. Хирургическое лечение в объеме пангистерэктомии должно обязательно проводиться при местно-распространенном заболевании, далее возможно применение адъювантной химиотерапии, но решение должно приниматься индивидуально. Проведение адъювантной лучевой терапии не показано, так как это не увеличивает общую выживаемость. Основным методом лечения диссеминированных лейомиосарком матки является комбинированная химиотерапия. В I линию лечения мы рекомендуем применять комбинированные схемы лечения с включением ифосфамида, доксорубицина, дакарбазина и гемцитабина, доцетаксела. Монотерапия трабектедином, в виде 24-часовой инфузии, показала хороший процент длительных стабилизаций и может применяться во II и более линии лечения. Применение гормональной терапии возможно в качестве поддерживающего лечения при положительном статусе рецепторов стероидных гормонов в опухоли. Решение о хирургическом лечении диссеминированного процесса должно приниматься индивидуально. Также представлены данные РОНЦ им. Н.Н. Блохина РАМН по применению трабектедина в лечении больных с лейомиосаркомами матки. Эффективность и токсичность сравнима с результатами международного исследования STS-201. При редукции дозы до 1,3 мг/м2 в виде 24-часовой инфузии значительно снижается токсичность при сохранении показателей эффективности, однако это требует дальнейшего изучения.

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