Uterine Sarcoma, Review of Advances in Management in the Last Decade

Uterine sarcomas are rare uterine malignancies. They represent a challenge right from preoperative diagnosis, primary treatment to management of recurrence. The objective of the review was to throw light on the new advances in its management and implications.

We collected all available data about uterine sarcoma including trials, systemic reviews, meta-analysis, consensus and guidelines from PubMed in last ten years. We critically analysed the evidences and have come up with this narrative review about the advances in uterine sarcoma management.

Use of immunohistochemistry and biomarkers including microRNA arrays on endoscopic guided biopsy have improved preoperative diagnostic accuracy. Sophisticated MRI imaging techniques and specific PET-CT imaging have helped categorising uterine sarcomas. Surgery has been the main stay of treatment with still minimal role of routine lymph node dissection. Ovarian preservation may be considered in select patients. Role of chemotherapy in primary setting in early cases is still controversial; however, use of trabectedin has shown promising results especially in advanced and recurrent settings. Use of targeted therapy especially tyrosine kinases like pazopanib has shown moderate responses. However, immune checkpoint inhibitors including pembrolizumab has not shown promising results. Research in field of targeted therapy is still in hope of finding ideal treatment. Hormonal treatment can be considered in hormone positive tumours in advanced malignancies. Radiotherapy can be considered in select high-risk cases.

Preoperative workup with specific biomarkers and advanced imaging are evolving in pinpointing the diagnosis. Although surgery still remains the absolute treatment, with better understanding of the genetic landscape and tumour biology of uterine sarcoma promising novel therapies for systemic treatment have been developed and is expected to further improve effective treatment options in near future.