Radiotherapy in uterine sarcoma: a narrative review of international guidelines

Uterine sarcomas (US) are a rare heterogeneous disease and their management is controversial, probably due to lack of strong evidence. The aim of this review was to summarize the available international guidelines on radiotherapy (RT) of uterine sarcoma. In this review we collected all available international clinical practice guidelines and consensus conference from PubMed database and other medical oncology societies. Analyzing the included documents, we collected, for each of them, indications for primary, adjuvant, and neoadjuvant treatment, based on the histological subtype. In total four international guidelines on RT in uterine sarcoma were identified. Surgery is considered as the first approach in early stages uterine sarcoma. Lymphadenectomy is suggested in carcinosarcoma and, for the other subtypes, only if enlarged nodes are observed. In advanced or metastatic US, the first approach is systemic treatment. In primary therapy, all guidelines exclude RT. Considering adjuvant therapy, in no histological type there are uniform indications among the different guidelines regarding RT. The use of neoadjuvant therapy, based on RT or systemic therapies, is not considered by any guideline. Therefore, the results of our analysis show clear uncertainty about the role of RT in uterine sarcoma. Further trials are needed to define the best treatment for each patient, mainly in high-risk local relapse patients where RT increases local control but benefit on survival is uncertain.