Multi-disciplinary management of advanced uterine sarcoma: a state of the art review

Uterine sarcomas are rare heterogeneous neoplasms, comprising only a small percentage of uterine malignancies. There is a diverse array of uterine sarcoma sub-types, each with distinct molecular, clinical, and behavioral features. In recent years, there has been significant advancement in all facets of the multi-disciplinary management of uterine sarcomas. Despite this, several challenges regarding optimization of treatment remain. While early-stage uterine sarcomas are potentially curable with surgery, there remains a high risk of recurrence, with the lungs and liver being common sites for distant spread. In the case of oligometastatic disease, local treatment may be offered in select patients and may improve survival. In the metastatic setting, advances in our histopathologic understanding of these rare cancers have allowed for the development and utilization of more targeted treatments; however, it is evident that there is a need for more efficacious and clinically meaningful therapeutic options. These patients often experience significant morbidity as a consequence of their disease and/or treatment, and palliative care support early in the disease course may improve quality of life and goal-concordant care. Additional large-scale, international multi-center collaboration is needed to further optimize multi-disciplinary management for these patients. In this review, we provide a comprehensive update on the management of advanced uterine sarcomas, and discuss novel therapeutic and supportive strategies in the multi-disciplinary management of these rare malignancies.