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Uterine Leiomyosarcoma — SCE Medical Oncology MCQ

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HardGynaecological CancersUterine LeiomyosarcomaSCE Medical Oncology

A 55-year-old woman is diagnosed with uterine leiomyosarcoma (LMS) after undergoing what was thought to be a hysterectomy for fibroids. Pathology shows high-grade LMS, stage IB (confined to uterus). What is the recommended management?

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Correct answer: D — Observation with surveillance (adjuvant chemotherapy is not standard for early-stage LMS)

Uterine leiomyosarcoma is managed differently from endometrial carcinoma. For early-stage (stage I-II) LMS, the role of adjuvant chemotherapy remains controversial. Adjuvant radiotherapy reduces local recurrence but has no OS benefit. Surveillance is the standard post-surgical approach for localised LMS after complete resection, given the absence of a proven OS benefit from adjuvant systemic therapy. BSO is not mandatory but may be considered. The GeDDiS trial showed no benefit of doxorubicin + gemcitabine over doxorubicin alone in advanced STS.

Reference: ESMO 2024 Uterine Sarcoma Guidelines; NICE NG; GeDDiS trial