Gard G B, Mulvany N J, Quinn M A
Department of Obstetrics and Gynaecology, University of Melbourne.
Aust N Z J Obstet Gynaecol. 1999 Feb;39(1):93-8. doi: 10.1111/j.1479-828x.1999.tb03453.x.
Uterine leiomyosarcoma is an uncommon malignancy for which the management varies widely between individual gynaecologists and gynaecological oncology units. We have performed a retrospective review of patients treated at both the Royal Women's Hospital in Melbourne (1970-1997) and King George V Hospital in Sydney (1987-1993). In addition we have performed a survey of Certified Gynaecological Oncologists (CGO's) to assess the current management of uterine leiomyosarcomas in Australia. The results show varied management practices exist in Australia, many of which are not supported by evidence in the current literature. Oophorectomy in the premenopausal patient appears unnecessary unless the ovaries are macroscopically involved. The role of pelvic lymphadenectomy is debatable. This practice was recommended by many CGO's, yet these nodes are rarely positive unless obvious extrauterine disease is present. Adjuvant chemotherapy appears not to have a role at present unless in a trial setting. Adjuvant radiotherapy does appear to have a potential palliative role as it prevents locoregional relapse, although survival is not prolonged. Until suitable phase 3 trials are available, gynaecological oncology units should be meticulous in prospectively recording the clinical course of their patients and critically analyzing their current management strategies.
子宫平滑肌肉瘤是一种罕见的恶性肿瘤，不同的妇科医生和妇科肿瘤治疗单位对其治疗方法差异很大。我们对墨尔本皇家妇女医院（1970 - 1997年）和悉尼乔治五世国王医院（1987 - 1993年）治疗的患者进行了回顾性研究。此外，我们还对澳大利亚妇科肿瘤专科医生进行了一项调查，以评估澳大利亚目前对子宫平滑肌肉瘤的治疗情况。结果显示，澳大利亚存在多种不同的治疗方法，其中许多方法在当前文献中缺乏证据支持。对于绝经前患者，除非卵巢肉眼可见受累，否则卵巢切除术似乎并无必要。盆腔淋巴结清扫术的作用存在争议。许多妇科肿瘤专科医生推荐这种做法，但除非存在明显的子宫外疾病，否则这些淋巴结很少呈阳性。目前，辅助化疗似乎并无作用，除非在试验环境中。辅助放疗似乎确实具有潜在的姑息作用，因为它可预防局部区域复发，尽管生存期并未延长。在有合适的3期试验之前，妇科肿瘤治疗单位应认真前瞻性记录患者的临床病程，并严格分析其当前的治疗策略。
