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Volume 2015, Article ID 704124, 14 pages
Review Article

Management Strategies in Advanced Uterine Leiomyosarcoma: Focus on Trabectedin

1Department of Obstetrics and Gynecology, UZ Gasthuisberg, Katholieke Universiteit Leuven, Herestraat 49, Box 7003, 3000 Leuven, Belgium
2Gynecologic Oncology Unit, Fondazione IRCCS National Cancer Institute, Via Venezian 1, 20133 Milan, Italy
3Department of Gynecology and Obstetrics, University Hospital Greifswald, Ferdinand-Sauerbruch-Strasse, 17475 Greifswald, Germany
4Department of Medical Oncology, La Timone University Hospital, 264 rue Saint Pierre, 13385 Marseille, France
5Département de Medecine, Institut Gustave-Roussy, 114 rue Edouard Vaillant, 94805 Villejuif Cedex, France

Received 19 February 2015; Accepted 28 April 2015

Academic Editor: Chandrajit Premanand Raut

Copyright © 2015 Frédéric Amant et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


The treatment of advanced uterine leiomyosarcomas (U-LMS) represents a considerable challenge. Radiological diagnosis prior to hysterectomy is difficult, with the diagnosis frequently made postoperatively. Whilst a total abdominal hysterectomy is the cornerstone of management of early disease, the role of routine adjuvant pelvic radiotherapy and adjuvant chemotherapy is less clear, since they may improve local tumor control in high risk patients but are not associated with an overall survival benefit. For recurrent or disseminated U-LMS, cytotoxic chemotherapy remains the mainstay of treatment. There have been few active chemotherapy drugs approved for advanced disease, although newer drugs such as trabectedin with its pleiotropic mechanism of actions represent an important addition to the standard front-line systemic therapy with doxorubicin and ifosfamide. In this review, we outline the therapeutic potential and in particular the emerging evidence-based strategy of therapy with trabectedin in patients with advanced U-LMS.