Surgical and Systemic Management of Advanced Uterine Sarcoma (FIGO Stage III and IV)
Advanced uterine sarcoma — encompassing FIGO stage III and stage IV disease — presents a surgical and oncological challenge requiring careful evaluation of disease extent, resectability, and the balance between achievable surgical margins and treatment morbidity.
Clinical Situation
This protocol addresses patients with uterine sarcoma at advanced stage (FIGO III or IV), where disease has extended beyond the uterus, involves peritoneal surfaces, regional or distant structures, or presents with metastases. The feasibility of complete macroscopic resection — including assessment of the number and location of metastases and primary tumour involvement — is central to treatment planning.
Treatment Approach (Partial Overview)
For advanced-stage disease, the structured protocol centres on complete surgical removal of macroscopic tumour as a primary objective, with the operative scope and sequencing of systemic therapy guided by stage and resectability status.
Full regimen details, sequencing, and eligibility criteria available in the complete protocol.
References
- For stage III, complete surgical removal of disease is the gold standard, including total hysterectomy and bilateral salpingo-oophorectomy and resection of any other suspicious lesions including peritoneal disease and/or bulky/suspicious nodes (IV, A).
- For stage IV, the option for primary resection depends on the number and location(s) of metastases as well as the biology and histological subtype.
- Surgery should be considered in primary oligometastatic disease together with complete surgical resection of primary tumor if it is deemed feasible with acceptable morbidity (IV, A).
- In cases of initially unresectable uterine sarcoma, primary systemic treatment is an option followed by re-evaluation for surgery depending on response (IV, B).
DOI: 10.1136/ijgc-2024-005823
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