Take-Away Points
■ Major Focus: To assess the safety and efficacy of liver-directed therapies of transarterial chemoembolization, radioembolization, and ablation for the treatment of leiomyosarcoma liver metastases.
■ Key Result: Liver-directed therapies are safe and show promising efficacy in this patient cohort.
■ Impact: Liver-directed therapies for treating leiomyosarcoma metastases warrant further evaluation and may prove an excellent tool in this cohort given the poor response to systemic treatment and associated toxicities.
Leiomyosarcoma that has metastasized to the liver connotes a poor prognosis and, while resection can improve survival, few patients are candidates for surgery. The foundation of treatment is therefore chemotherapy, and the first-line agent is doxorubicin (with or without ifosfamide). Response rates are poor, and progression-free survival is reported to be as low as 5 months (1). Furthermore, systemic doxorubicin carries clinically significant toxicities, including bone marrow suppression and alopecia.
Krzyston and colleagues recently published their experience with treating 24 patients with leiomyosarcoma liver metastases using liver-directed therapies, namely with doxorubicin-eluting bead transarterial chemoembolization, radioembolization, or ablation. The majority of patients had been pretreated with chemotherapy and had extrahepatic metastases but with dominant disease in the liver. From the time of liver-directed treatment, median overall survival and progression-free survival were both 9 months, with the overall survival increasing to 22 months in patients with disease limited to the liver. There were no reported systemic complications of doxorubicin for those patients undergoing transarterial chemoembolization.
While the number of patients treated here is small and the outcomes are not reported separately for the different treatment methods, the results are encouraging and merit further evaluation. It may be that interventional radiology plays an important role in treating these patients in the future, either as an alternative to front-line chemotherapy or as a salvage option.
Highlighted Article
Krzyston H, Morse B, Deperalta D, et al. Liver-directed treatments of liver-dominant metastatic leiomyosarcoma. Diagn Interv Radiol 2020;26(5):449–455. doi: 10.5152/dir.2020.19405
Reference
- 1.Judson I, Verweij J, Gelderblom H, et al. Doxorubicin alone versus intensified doxorubicin plus ifosfamide for first-line treatment of advanced or metastatic soft-tissue sarcoma: a randomised controlled phase 3 trial. Lancet Oncol 2014;15(4):415–423. [DOI] [PubMed] [Google Scholar]
Highlighted Article
- Krzyston H, Morse B, Deperalta D, et al. Liver-directed treatments of liver-dominant metastatic leiomyosarcoma. Diagn Interv Radiol 2020;26(5):449–455. doi: 10.5152/dir.2020.19405 [DOI] [PMC free article] [PubMed] [Google Scholar]