Gastrointestinal leiomyosarcoma demonstrate a predilection for distant recurrence and poor response to systemic treatments

Eur J Surg Oncol. 2021 Oct;47(10):2595-2601. doi: 10.1016/j.ejso.2021.04.043. Epub 2021 May 4.


Background: Primary leiomyosarcoma (LMS) of the gastrointestinal (GI) tract is rare. Limited literature exists regarding the clinical characteristics and outcome for patients with localised and metastatic disease.

Methods: A retrospective chart review was performed for patients greater than 18 years of age diagnosed with GI LMS at The Royal Marsden Hospital between 1 January 2000-1 May 2020. Descriptive statistics were performed. Patients were censored at data cut-off date of 27 June 2020.

Results: Forty-six patients with a median age at diagnosis of 54 years (range 25-85) were identified. Fifteen percent (n = 7) of patients previously received abdominal radiation for an unrelated cancer. All patients with localised disease (n = 36) had resection with oncological margins. For patients who underwent potentially curative surgery, median recurrence-free survival (mRFS) was 13 months (0.4-183 months), and half of these patients (n = 18) developed recurrent disease post resection (distant n = 16, local n = 2). Median overall survival (mOS) was 27 months for patients with distant recurrence. Twenty-one percent (n = 10) of patients presented with synchronous metastatic disease and their mOS was 19 months. Median progression-free survival (mPFS) for patients treated with conventional chemotherapy ranged from 2.0 to 8.0 months.

Conclusion: The risk of recurrence is significant, and recurrence-free survival was short even with complete oncologic resection. The relationship of prior abdominal radiotherapy to the development of GI LMS warrants further investigation. Outcomes with systemic therapy for metastatic disease were poor and there is a need for the development of more effective systemic therapies.

Keywords: Leiomyosarcoma; Radiation induced sarcoma; Soft tissue sarcoma; Surgery; Systemic therapy.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Antineoplastic Agents / therapeutic use
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Chemotherapy, Adjuvant
  • Female
  • Gastrointestinal Neoplasms / pathology*
  • Gastrointestinal Neoplasms / therapy*
  • Humans
  • Kaplan-Meier Estimate
  • Leiomyosarcoma / secondary*
  • Leiomyosarcoma / therapy*
  • Male
  • Margins of Excision
  • Metastasectomy
  • Middle Aged
  • Neoplasm Recurrence, Local / therapy*
  • Neoplasms, Radiation-Induced / physiopathology*
  • Neoplasms, Radiation-Induced / therapy*
  • Progression-Free Survival
  • Radiotherapy / adverse effects
  • Retrospective Studies
  • Survival Rate


  • Antineoplastic Agents