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Original Research

Open Access

Treatment patterns for leiomyosarcomas, endometrial stromal sarcomas and adenosarcomas: a national cancer database study

  • Jessica Kunzman1
  • Ryan Hutten2,3
  • Kristen Kelley1
  • Kate Harris3,4
  • David K. Gaffney2,3
  • Cristina DeCesaris2,3
  • Gita Suneja2,3
  • Lindsay M. Burt2,3,*,

1University of Utah School of Medicine, Salt Lake City, UT 84112, USA

2Department of Radiation Oncology, University of Utah School of Medicine, Salt Lake City, UT 84112, USA

3Huntsman Cancer Institute, Salt Lake City, UT 84112, USA

4Department of Gynecologic Oncology, University of Utah School of Medicine, Salt Lake City, UT 84112, USA

DOI: 10.22514/ejgo.2023.019 Vol.44,Issue 2,April 2023 pp.25-31

Submitted: 01 November 2022 Accepted: 16 March 2023

Published: 15 April 2023

*Corresponding Author(s): Lindsay M. Burt E-mail:


Uterine sarcomas are a rare, heterogenous, group of cancers with limited data on optimal adjuvant treatment. We examined patterns of care for leiomyosarcomas (LMS), endometrial stromal sarcomas (ESS), adenosarcomas (AS), and mixed uterine sarcomas and assessed the utilization of adjuvant therapy for each histology. The National Cancer Database (NCDB) was queried for patients with non-metastatic uterine sarcoma diagnosed between 2004 and 2018 treated with surgery. Uterine carcinosarcomas were excluded. Adjuvant patterns of care and temporal treatment trends are evaluated, stratified by histology. Multivariable logistic regression model was constructed to identify predictors of receipt of radiation adjuvant therapy. Among 12,806 patients, 88% received a total hysterectomy and bilateral salpingo-oophorectomy (TH+BSO) and 42% received lymph node sampling (LNS). Surgery alone was the most common treatment modality for all histology groups (59.0%). Surgery with chemotherapy was the second most common form of treatment for LMS (33.1%) and mixed type tumors (29.6%). Surgery with radiation was the second most common treatment for high-grade ESS (10.8%) and AS (11.8%). External beam radiation therapy (EBRT) was the most common type of adjuvant radiation therapy utilized. Adjuvant radiation therapy (RT) has declined in LMS, from 27% in 2004 to 3% in 2018. Adjuvant chemotherapy for all histology groups has increased in use from 10% in 2004 to 28% in 2018. For uterine sarcomas, TH+BSO without LNS was the main surgical modality. Adjuvant therapy for uterine sarcomas is not commonly used, however high risk features including stage II/III, high grade, and more extensive lymph node sampling appear to increase the likelihood of adjuvant RT. The utilization of adjuvant chemotherapy in uterine sarcomas has increased over time, while RT has been decreasing.


Uterine sarcoma; Treatment; Radiation therapy; Chemotherapy; Surgery; Leiomyosarcoma; Endometrial stromal sarcoma; Adenosarcoma

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Jessica Kunzman,Ryan Hutten,Kristen Kelley,Kate Harris,David K. Gaffney,Cristina DeCesaris,Gita Suneja,Lindsay M. Burt. Treatment patterns for leiomyosarcomas, endometrial stromal sarcomas and adenosarcomas: a national cancer database study. European Journal of Gynaecological Oncology. 2023. 44(2);25-31.


[1] SEER. Cancer of the endometrium. 2022. Available at: https://seer. (Accessed: 01 December 2022).

[2] Clarke MA, Devesa SS, Harvey SV, Wentzensen N. Hysterectomy-corrected uterine corpus cancer incidence trends and differences in relative survival reveal racial disparities and rising rates of nonendometrioid cancers. Journal of Clinical Oncology. 2019; 37: 1895–1908.

[3] Brooks SE, Zhan M, Cote T, Baquet CR. Surveillance, epidemiology, and end results analysis of 2677 cases of uterine sarcoma 1989–1999. Gynecologic Oncology. 2004; 93: 204–208.

[4] McCluggage WG. Malignant biphasic uterine tumours: carcinosarcomas or metaplastic carcinomas? Journal of Clinical Pathology. 2002; 55: 321–325.

[5] Abeler VM, Røyne O, Thoresen S, Danielsen HE, Nesland JM, Kristensen GB. Uterine sarcomas in Norway. A histopathological and prognostic survey of a total population from 1970 to 2000 including 419 patients. Histopathology. 2009; 54: 355–364.

[6] Livi L, Paiar F, Shah N, Blake P, Villanucci A, Amunni G, et al. Uterine sarcoma: twenty-seven years of experience. International Journal of Radiation Oncology, Biology, Physics. 2003; 57: 1366–1373.

[7] Sorbe B, Johansson B. Prophylactic pelvic irradiation as part of primary therapy in uterine sarcomas. International Journal of Oncology. 2008; 32: 1111–7.

[8] Reed NS, Mangioni C, Malmström H, Scarfone G, Poveda A, Pecorelli S, et al. Phase III randomised study to evaluate the role of adjuvant pelvic radiotherapy in the treatment of uterine sarcomas stages I and II: an european organisation for research and treatment of cancer gynaecological cancer group study (protocol 55874). European Journal of Cancer. 2008; 44: 808–18.

[9] Lerro CC, Robbins AS, Phillips JL, Stewart AK. Comparison of cases captured in the national cancer data base with those in population-based central cancer registries. Annals of Surgical Oncology. 2013; 20: 1759–65.

[10] StataCorp. Stata 14 Base Reference Manual. Stata Press: College Station, TX. 2015.

[11] Barney BM, Petersen IA, Dowdy SC, Bakkum-Gamez JN, Haddock MG. Long-term outcomes with intraoperative radiotherapy as a component of treatment for locally advanced or recurrent uterine sarcoma. International Journal of Radiation Oncology, Biology, Physics. 2012; 83: 191–197.

[12] Seagle BL, Shilpi A, Buchanan S, Goodman C, Shahabi S. Low-grade and high-grade endometrial stromal sarcoma: a national cancer database study. Gynecologic Oncology. 2017; 146: 254–262.

[13] Chan JK, Kawar NM, Shin JY, Osann K, Chen L, Powell CB, et al. Endometrial stromal sarcoma: a population-based analysis. British Journal of Cancer. 2008; 99: 1210–1215.

[14] El-Khalfaoui K, du Bois A, Heitz F, Kurzeder C, Sehouli J, Harter P. Current and future options in the management and treatment of uterine sarcoma. Therapeutic Advances in Medical Oncology. 2014; 6: 21–28.

[15] Hensley ML, Enserro D, Hatcher H, Ottevanger PB, Krarup-Hansen A, Blay J, et al. Adjuvant Gemcitabine Plus Docetaxel Followed by Dox-orubicin Versus Observation for High-Grade Uterine Leiomyosarcoma: a Phase III NRG oncology/gynecologic oncology group study. Journal of Clinical Oncology. 2018; 36: 3324–3330.

[16] NCCN. Uterine Neoplasms (Version 1.2022). 2021. Available at: (Accessed: 15 March 2022).

[17] Major FJ, Blessing JA, Silverberg SG, Morrow CP, Creasman WT, Currie JL, et al. Prognostic factors in early-stage uterine sarcoma: a gynecologic oncology group study. Cancer. 1993; 71: 1702–1709.

[18] Diggs A, Sia TY, Huang Y, Gockley A, Melamed A, Khoury-Collado F, et al. Utilization and outcomes of adjuvant therapy for stage II and III uterine leiomyosarcoma. Gynecologic Oncology. 2022; 166: 308–316.

[19] Salazar OM, Bonfiglio TA, Patten SF, Keller BE, Feldstein M, Dunne ME, et al. Uterine sarcomas: natural history, treatment and prognosis. Cancer. 1978; 42: 1152–60.

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