Treatment of Uterine Sarcoma in High-Grade Uterine Adenosarcoma with Sarcomatous Overgrowth

High-grade uterine adenosarcoma with sarcomatous overgrowth is a distinct and aggressive histological variant of uterine sarcoma. Its clinical behaviour warrants a management strategy aligned with other high-grade uterine sarcomas.

Clinical Scenario

This protocol applies to patients with uterine sarcoma in the specific setting of high-grade uterine adenosarcoma with sarcomatous overgrowth — a subtype recognised for aggressive histological features that influence both surgical and post-operative decision-making.

Treatment Approach

For localised disease, surgery is the cornerstone of management. Recommendations regarding the role and scope of post-operative therapy at stage I differ from later-stage disease — the full protocol details the complete staging-based algorithm, including the evidence basis for adjuvant decisions.

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References

DOI: 10.1136/ijgc-2024-005823

High-grade sarcomas should be managed with chemotherapy, similar to the approach in other high-grade uterine sarcomas due to similar efficacy with options including doxorubicin as a single agent or combined with ifosfamide.
The recommended treatment for uterine adenosarcomas is a total hysterectomy and bilateral salpingo-oophorectomy, as the majority of patients are peri-/post-menopausal.
Post-operative chemotherapy is not the standard of care for stage I disease (V, D).

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