Adjuvant radiotherapy in recurrent pleomorphic leiomyosarcoma of spermatic cord: A case report and literature review

Pleomorphic leiomyosarcoma of spermatic cord is a very rare urologic disease, so there are no clear guidelines. The mainstay of treatment is surgery with wide excision margins. The role of adjuvant treatments, such as Chemotherapy (CHT) or Radiotherapy (RT), is not clear, due to the few data available in the literature. However, adjuvant treatments could be considered in patients with a high risk of local recurrence: R1 status after surgery and highgrade histology. We report the case of 68-year old man affected by recurrent pleomorphic leiomyosarcoma of spermatic cord right, who, in five years, underwent many surgical treatments for local recurrence, and also adjuvant CHT. The last surgery shows positive margins. Therefore, the patient receive adjuvant RT on the surgical bed and right inguinal nodes with a dose of 54 Gy in 27 fractions and VMAT technique. The treatment was well tolerated, the follow-up at 12 months is negative for local recurrence and show absence of toxicity. However a long-term follow-up is necessary to confirm the efficacy of radiotherapy on outcomes and especially on local control. Keywords: pleomorphic leiomyosarcoma; recurrence; positive margins; adjuvant radiotherapy