Management of peripheral-vein leiomyosarcomas, recurrence patterns and individualised treatment strategy

Peripheral vein leiomyosarcomas (LMS) are rare soft tissue sarcomas with high metastatic potential. While radiotherapy (RT) is commonly used in high-grade soft tissue sarcomas to improve local control, its benefit in peripheral vein LMS remains unclear, particularly due to their anatomical location and low local recurrence rates.

A retrospective analysis was conducted on 141 patients who underwent surgery for peripheral vein LMS between 2000 and 2023. Inclusion required histopathological confirmation by sarcoma-specialist pathologists. Clinical, pathological, and treatment-related data were collected, including use of radiotherapy and recurrence outcomes. Recurrence-free and overall survival were analysed.

Median patient age was 68 years. Most tumours were located in the lower extremity, originating from the greater saphenous or femoral veins. Radiotherapy was administered to 24.1 % of patients, with limited radiological or pathological response observed. Local recurrence was rare (7.1 %) and not significantly associated with RT, tumour depth, grade, or margin status. Distant recurrence occurred in 27.8 % of patients with localised disease. On multivariate analysis, deep tumour location (OR 3.1, p < 0.001) and high-grade histology (OR 15.9, p = 0.010) were the only significant predictors of distant recurrence.

Peripheral vein LMS demonstrates a low local recurrence but high metastatic risk. Radiotherapy did not significantly impact local control, and it was typically utilized in higher-grade, deep-seated tumours that carry a greater risk of local relapse. These findings suggest that in peripheral vein LMS, systemic risk outweighs local control benefits from RT, highlighting the need for individualised treatment strategies and further prospective studies.