Introduction/Background Uterine sarcomas are a heterogeneous group of rare mesenchymal tumors that account for 4% of malignant tumors of the uterus. They include leiomyosarcoma, low-grade endometrial stromal sarcoma (ESS), high-grade ESS, undifferentiated sarcoma and adenosarcoma (WHO, 2020). Although primary treatment is surgical, there is no evidence in favor of adjuvant treatment, but given the high rate of recurrence and poor prognosis it could be used in high-risk sarcomas.

Our objective is to evaluate clinical management, the addition of adjuvant treatment and outcomes in women with uterine sarcomas.

Methodology Retrospective study of women treated in a tertiary center in Madrid (Spain) with uterine sarcoma from 2009 to 2022.

Results Twenty-eight women were recruited. Twenty-one patients were uterine leiomyosarcomas (75%, 21/28), 1 low-grade ESS (3.6%, 1/28), 1 high-grade ESS (14.3%, 4/28), 2 undifferentiated sarcoma (7.1%, 2/28) and 3 adenosarcomas (10.7%, 3/28). The surgical stages of the tumours were IA: n:2; IB n:12; IIB n:3; IIIA-B n:4; IVA-B n:7. Mean age of patients was 59.3 years (range: 37–80). Surgical management was performed in 25 women, for postmenopausal metrorrhagia (n:8, 32.0%), persistent pain (n:7, 28.0%), hypermenorrhea (n:3, 12.0%) or suspicious myomas (n:6, 24.0%) with hysterectomy and double adnexectomy (n:21, 84.0%), tumor biopsy/partial resection (n: 2, 8.0%) or total cytoreduction (n:2, 8.0%). Adjuvant chemotherapy was administered in 10 patients (35.7%, 10/28) including gemcitabine, doxorubicin or adriamycin. Initial radiotherapy was given in 7 women (25.0%, 7/28). Fourteen women (50%, 14/28) had some type of recurrence: peritoneal (n:5), pulmonary (n:4), pulmonary and peritoneal (n:1), other (n:4).

Sixteen women (57.1%, 16/28) died in the study period with a mean survival time of 768 days (range: 8–1999 days) after surgery. Survival women had a follow-up period ranging 16 months-13 years.

Conclusion Uterine sarcoma can be a threatening condition regardless of surgical, chemotherapeutic or radiotherapy treatment with high mortality rate and recurrence.

Disclosures The clinical management of uterine sarcomas is complex. We must be aware of possible recurrences despite surgical, chemo or radiotherapy treatment, especially at the pulmonary and peritoneal level, assuming a high mortality rate.