Treatment for leiomyosarcoma depends on where the cancer started, its size, stage and grade, whether it can be completely removed with surgery, and your overall health.
LMS that has not spread to other parts of the body can sometimes be treated with the goal of cure, especially when surgery can remove all of the cancer.
Because LMS is rare, it may be helpful to get treatment at a center that regularly treats sarcoma or to consult with a center that does.
Surgery
Surgery is the main treatment for many leiomyosarcomas that have not spread to distant parts of the body. When possible, the goal is to remove all of the cancer along with a small amount of tissue around it.
The operation depends on where the cancer started.
- For uterine LMS, surgery may include removal of the uterus, called a hysterectomy.
- For LMS in the retroperitoneum, surgery may require removing the tumor along with nearby tissue or organs affected by cancer.
- For LMS of the inferior vena cava, surgery may involve removing the part of the vein that contains the tumor. Surgeons may need to repair or reconstruct the vein.
If LMS has spread to only one or a few places, surgery or another treatment directed at those tumors may be considered in some situations.
Radiation therapy
Radiation therapy uses powerful energy beams to damage cancer cells.
Radiation therapy may be used before or after surgery. It also may be used to treat a tumor that cannot be removed or to ease symptoms caused by cancer that has spread.
Whether radiation therapy is useful depends on where the LMS started and the details of the cancer.
Chemotherapy
Chemotherapy uses medicine to kill cancer cells. It is not needed for every leiomyosarcoma. Your healthcare team may talk with you about chemotherapy before or after surgery. Chemotherapy may help prevent LMS from spreading or returning after surgery. Chemotherapy also may be used when LMS cannot be removed with surgery or has spread to distant parts of the body.
Doxorubicin (Adriamycin) is one medicine commonly used for advanced LMS. Doxorubicin may be given alone or in combination with other chemotherapy.
Other options can include gemcitabine-based chemotherapy, trabectedin, dacarbazine and eribulin. The choice depends on treatments already received, where the LMS started, other health conditions and the expected benefits and side effects.
Targeted therapy
Targeted medicines act on features that help cancer cells grow. Pazopanib (Votrient) may be an option for some people with advanced LMS.
Treatment for metastatic leiomyosarcoma
LMS that has not spread to other parts of the body can sometimes be treated with the goal of cure, especially when surgery can remove all of the cancer. But once LMS has spread widely, cure is less common. Treatment may still shrink the cancer, slow its growth, ease symptoms and help people live longer.
For metastatic LMS, medicine that treats cancer throughout the body is often the main treatment. Surgery, radiation therapy or other local treatments also may be considered when there are only a few areas of spread or when a tumor is causing symptoms.