NLMSF Research Hub

Uterine Leiomyosarcoma (uLMS)

Clinically relevant research, reviews, clinical trials, and education focused on uterine leiomyosarcoma.

Genomics Clinical Trials Reviews Expert Video

International Panel Review (IJGC 2025)

Uterine Leiomyosarcoma — International Panel Review

International Journal of Gynecological Cancer · September 2025

Biology

Multifactorial pathogenesis with complex cytogenetic/molecular alterations (TP53, RB1; chromothripsis patterns).

Diagnosis

Preoperative distinction from leiomyoma remains difficult; MRI/CT assist but no single definitive test. Avoid morcellation when malignancy is suspected.

Primary Treatment

Stage I: en bloc total hysterectomy +/- BSO; routine lymphadenectomy not indicated without bulky nodes. Multidisciplinary care emphasized.

Advanced / Recurrent

Aim for complete resection when feasible; adjuvant chemo/RT evidence is mixed. Systemic options are doxorubicin-based; consider RT and multimodal strategies.

Follow-up

Regular clinical and imaging surveillance due to high early recurrence risk; patterns often distant (lung/liver).

Guidelines

ESGO/EURACAN/GCIG recommendations summarized; notable international practice differences persist.

Read the Full IJGC 2025 Review

Expert Video

Uterine Sarcoma Care — Key Considerations

Multidisciplinary expertise in evaluation, treatment planning, and second opinions

For an overview of comprehensive sarcoma services see the UCLA Health Sarcoma Center.

Featured Publication

PMC · November 2024

Uterine Smooth Muscle Tumors of Uncertain Malignant Potential — A 13-Year Retrospective Study

Comprehensive retrospective study informing diagnosis and management for uterine smooth muscle tumors of uncertain malignant potential.

Genomic Risk Stratification

Novel Risk Models for LMS

Addressing heterogeneity gaps in current tools

Developing Novel Genomic Risk Stratification Models

Dermawan JK et al. propose a clinically applicable genomic risk model for LMS, addressing heterogeneity and current gaps.

Clinical Cancer Research (2024)

Transcriptome Profiling: Leiomyoma-Like Program Indicates Better Survival

Multi-cohort transcriptomic profiling identifies a subset of uterine LMS with a leiomyoma-like expression pattern associated with more favorable outcomes.

Nature (2025)

Targeted Therapy

The Future of Targeted Therapy for LMS

MD Anderson Cancer Center · 2024 Review

Explores DNA damage response, macrophage-rich microenvironment, PI3K/mTOR pathway, epigenetic regulators, and telomere biology as therapeutic targets.

Cancers (2024) · Full Text

Hormone Therapy: Aromatase Inhibitors

Letrozole and AI Use in uLMS

Expert insight from Dana-Farber Cancer Institute

Q: Is Letrozole best for stage I/II uLMS or advanced stages III/IV?

A: Letrozole has been best studied (though small studies) in the metastatic setting. It is really not clear how much benefit these drugs have, but anecdotally patients can benefit.— Matt Hemming, MD, Dana-Farber / LMS Research Roundtable

DFCI PublicationCancer Journal AI TreatmentAdvanced uLMS Phase II LetrozoleER/PR+ uLMS Hormone-Positive uLMSAromatase Inhibitors

Recruiting Clinical Trials

Live from ClinicalTrials.gov

Currently recruiting trials for uterine leiomyosarcoma

5 trials currently recruiting or enrolling · Data from ClinicalTrials.gov · Updated daily

NOT YET RECRUITINGPhase 2

Phase II Decentralized Pragmatic Trial of Adjuvant Doxorubicin - Trabectedin Chemotherapy in uLMS

To find out if receiving standard chemotherapy (doxorubicin and trabectedin) can extend the cancer-free survival of patients with Stage 1b/2 uterine leiomyosarcoma who had surgery…

M.D. Anderson Cancer Center Houston, Texas, United States

NCT07076186

RECRUITINGPhase 2

MASCT-I Combined With Doxorubicin and Ifosfamide for First-line Treatment of Advanced Soft Tissue Sarcoma

This study will evaluate the safety and efficacy of MASCT-I combined with Doxorubicin and Ifosfamide for first-line treatment in patients with advanced soft tissue sarcoma.

HRYZ Biotech Co. Guangzhou, China

NCT06277154

RECRUITINGN/A

Rare Disease Patient Registry & Natural History Study - Coordination of Rare Diseases at Sanford

CoRDS, or the Coordination of Rare Diseases at Sanford, is based at Sanford Research in Sioux Falls, South Dakota. It provides researchers with a centralized, international…

Sanford Health Sioux Falls, South Dakota, United States +1 more

NCT01793168

RECRUITINGPhase 2

Interest of Post-operative Chemotherapy in Patients With Localised Uterine Leiomyosarcoma Suspected of Having a High Risk of Recurrence Based on a Biological Test Performed on the Tumour

Addition of postoperative chemotherapy to prevent or delay recurrence in patients newly diagnosed with localized uterine leiomyosarcoma and who have undergone complete tumor…

UNICANCER Angers, France +24 more

NCT06524583

RECRUITINGPhase 2

Letrozole in Uterine Leiomyosarcoma

This is a clinical trial to test letrozole in patients with uterine leiomyosarcoma. The main question is will treatment with letrozole extend progression-free survival in…

GOG Foundation Aurora, Colorado, United States +12 more

NCT05649956

Loading active trials from ClinicalTrials.gov…

Treatment Research

Temozolomide + Olaparib

Encouraging efficacy and manageable safety in uLMS

OncLive

Adjuvant Therapy Outcomes

Utilization and outcomes for stage II & III uLMS

PubMed

Targeting UCP2 in uLMS

Novel therapeutic strategies

ScienceDirect

Unesbulin

Promising new drug with clinical efficacy in LMS (ASCO)

PR Newswire

Anlotinib for Advanced Sarcomas

Long-term efficacy and safety data

PubMed

Staging & Treatment Guidelines

uLMS Treatment by Stage

American Cancer Society guidelines

Stages I & II

Standard surgery is hysterectomy with BSO; lymph node evaluation as indicated. Adjuvant radiation may reduce local recurrence; chemo is considered in higher-risk cases.

Stage III

Debulking/definitive surgery followed by radiation +/- chemo depending on risk of recurrence.

Stage IV

IVA may be operable; otherwise radiation/chemo or both. IVB managed with systemic therapy; targeted therapy when appropriate.

Download Uterine LMS Staging Chart (PDF)

More Research & Videos

ASCO 2022: Novel Therapeutics in Uterine Sarcoma

Dr. Matthew Ingham, Columbia University Medical Center

NLMSF Patient-Caregiver Advocacy Roundtable

Dr. Ingham's presentation to the NLMSF advocacy roundtable

uLMS Clinical Trial Update

Dr. Gary Schwartz on the Phase III uLMS trial progress

Molecular Insights in Uterine Leiomyosarcoma

Systematic review — Int. Journal of Molecular Sciences

LMS: Current Clinical Management and Future Horizon

Comprehensive review — PubMed

Ultrasound Evaluation of Leiomyosarcoma

Overlap of suspicious and non-suspicious features — single center