Long-term survival following serial pulmonary metastasectomies for uterine leiomyosarcoma: a case report

In patients with uterine leiomyosarcoma and multiple pulmonary metastases complicated by pneumothorax during chemotherapy, repeated metastasectomy may contribute to long-term survival.

A 45-year-old woman underwent total hysterectomy for uterine leiomyosarcoma. She subsequently developed multiple pulmonary metastases and was treated with gemcitabine plus docetaxel (GD) chemotherapy. During the course of chemotherapy, she developed a pneumothorax, possibly as a consequence of tumor necrosis induced by treatment. Due to a rapidly declining in the performance status (PS), right lower lobectomy was performed to manage the pneumothorax and reduce the tumor burden. GD chemotherapy was resumed postoperatively but discontinued after a total of 14 cycles due to adverse events. As anticipated, the pulmonary metastases regrew. However, no evidence of extrathoracic disease was identified, and her respiratory function was deemed sufficient for surgery. She subsequently underwent one-stage partial bilateral lung resections, during which a total of 12 metastatic nodules were removed. Two years later, two additional metastatic lesions were resected. Since that time, 5 years and 8 months have passed without any recurrence or additional treatment. At the time of reporting, the patient had remained disease-free, 16 years after the initial hysterectomy, with PS of 0.

Uterine leiomyosarcoma is an aggressive tumor; however, in selected cases, long-term survival may be achieved through multimodal treatment approaches, including surgical resection of metastatic lesions.