Management of uterine leiomyosarcoma in Australia

Uterine leiomyosarcoma is an uncommon malignancy for which the management v aries widely between individual gynaecologists and gynaecological oncology units. We have performed a retrospective review of patients treated at both the Royal Women's Hospital in Melbourne (1970-1997) and King George V Hosp ital in Sydney (1987-1993). In addition we have performed a survey of Certi fied Gynaecological Oncologists (CGO's) to assess the current management of uterine leiomyosarcomas in Australia. The results show varied management p ractices exist in Australia, many of which are not supported by evidence in the current literature. Oophorectomy in the premenopausal patient appears unnecessary unless the ovaries are macroscopically involved. The role of pe lvic lymphadenectomy is debatable. This practice was recommended by many CG O's, yet these nodes are rarely positive unless obvious extrauterine diseas e is present. Adjuvant chemotherapy appears not to have a role at present u nless in a trial setting. Adjuvant radiotherapy does appear to have a poten tial palliative role as it prevents locoregional relapse, although survival is not prolonged. Until suitable phase 3 trials are available, gynaecologi cal oncology units should be meticulous in prospectively recording the clin ical course of their patients and critically analyzing their current manage ment strategies.