Leiomyosarcoma: the decisions you may face

Cancer page →Second-opinion finder →

3 treatment settings, 2 with more than one named option. Each section lays out the options the standard of care names, what each is for, the trials behind them with their recorded results, the side effects and cautions on record, and questions to ask. Built from the cancer page's standard-of-care rows; nothing here is advice for your case.

Early / localised

Localised

One path named

Wide surgical resection; radiotherapy for limb and trunk tumours; no morcellation of uterine masses that could be sarcoma; adjuvant chemotherapy not standard.

The path, in plain words

IMRT / IGRT (modern external beam)Standard of care

IMRT and IGRT shape the radiation beam to the tumour's outline from multiple angles and check the patient's position with a scan before every session, so surrounding organs receive less dose. Fewer, larger doses are now standard in breast and prostate cancer, but a low-dose bath still spreads across normal tissue.

Conformal dose, fewer side effects
Hypofractionation saves visits

The evidence behind it

No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.

The main trade-offs on record

IMRT / IGRT (modern external beam)

Low-dose bath to normal tissue
Motion management

Questions to ask about this decision

Is IMRT / IGRT (modern external beam) the only reasonable path for me, or is there a trial, a different sequence or a wait-and-see option?
Why: A single standard does not mean a single choice; timing and trials are decisions too.
What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
Why: The aim shapes how much side effect and disruption is worth accepting.
What happens if I delay, or decline this step for now? Is the decision reversible?
Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
For my situation (localised), which of the standard options do you recommend and why?
Why: Guideline options include: Wide surgical resection; radiotherapy for limb and trunk tumours; no morcellation of uterine masses that could be sarcoma; adjuvant chemotherapy not standard.

Add these to your appointment list, or take the full question set for this cancer.

Advanced, first line

Metastatic, first line

4 optionsCompare side by side →

Doxorubicin plus trabectedin (LMS-04) or doxorubicin alone; gemcitabine-docetaxel as an alternative, especially in uterine disease.

The options, in plain words

DoxorubicinApprovedCytotoxic chemotherapy (anthracycline)

The red chemotherapy drug from a soil bacterium that is still the backbone of treatment for sarcoma, lymphoma and breast cancer, limited by cumulative heart damage.

TrabectedinApprovedCytotoxic (DNA minor-groove binder)

A chemotherapy derived from a sea squirt, used with liposomal doxorubicin in relapsed ovarian cancer in Europe and for sarcomas.

GemcitabineApprovedNucleoside analogue (deoxycytidine)

A versatile chemotherapy used in pancreatic, bladder, lung, ovarian, breast and biliary cancers, in nasopharyngeal cancer, and as a bladder instillation.

DocetaxelApprovedCytotoxic chemotherapy (taxane)

The first chemotherapy to extend life in prostate cancer (2004), now part of triplet therapy at first metastatic diagnosis.

The evidence behind it

No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.

The main trade-offs on record

Doxorubicin all recorded rates →

Cumulative dose: risk rises steeply above 400-550 mg/m² (see the anthracycline calculator).
Reduce by 50% for bilirubin 20-50 µmol/L and 75% for 50-85 µmol/L.

Trabectedin all recorded rates →

Alcohol: avoid (hepatotoxicity). Dexamethasone 20 mg before each dose protects the liver.
Reduce to 0.9 mg/m² in moderate impairment; avoid in severe.

Docetaxel all recorded rates →

Do not give if bilirubin above ULN, or AST/ALT above 1.5 x ULN with alkaline phosphatase above 2.5 x ULN (treatment-related deaths).

Questions to ask about this decision

Between Doxorubicin, Trabectedin, Gemcitabine and the other options, which do you recommend for me, and what about my case would make you choose differently?
Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
Why: The aim shapes how much side effect and disruption is worth accepting.
What happens if I delay, or decline this step for now? Is the decision reversible?
Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
For my situation (metastatic, first line), which of the standard options do you recommend and why?
Why: Guideline options include: Doxorubicin plus trabectedin (LMS-04) or doxorubicin alone; gemcitabine-docetaxel as an alternative, especially in uterine disease.
Am I a candidate for Doxorubicin, Trabectedin, Gemcitabine or related drugs, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Add these to your appointment list, or take the full question set for this cancer.

Third line and beyond

Later lines

3 optionsCompare side by side →

Trabectedin, pazopanib, dacarbazine-based regimens, aromatase inhibitors in hormone receptor-positive low-grade uterine disease; metastasectomy for limited lung spread.

The options, in plain words

TrabectedinApprovedCytotoxic (DNA minor-groove binder)

A chemotherapy derived from a sea squirt, used with liposomal doxorubicin in relapsed ovarian cancer in Europe and for sarcomas.

PazopanibApprovedSmall-molecule kinase inhibitor (VEGFR/PDGFR/KIT)

Pazopanib is the only multi-kinase inhibitor approved for soft-tissue sarcoma (excluding fat-derived tumours), used after chemotherapy fails.

Letrozole (and other aromatase inhibitors)ApprovedSmall-molecule aromatase inhibitor

Daily pills that stop the body making oestrogen after menopause, the backbone of hormone therapy for most breast cancers.

The evidence behind it

No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.

The main trade-offs on record

Trabectedin all recorded rates →

Alcohol: avoid (hepatotoxicity). Dexamethasone 20 mg before each dose protects the liver.
Reduce to 0.9 mg/m² in moderate impairment; avoid in severe.

Pazopanib all recorded rates →

Take on an empty stomach (1 hour before or 2 hours after food).
Known QT prolongation. Avoid other QT-prolonging drugs where possible; check ECG and correct potassium and magnesium before and during treatment.
200 mg daily in moderate impairment; avoid in severe.

Questions to ask about this decision

Between Trabectedin, Pazopanib and Letrozole (and other aromatase inhibitors), which do you recommend for me, and what about my case would make you choose differently?
Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
Why: The aim shapes how much side effect and disruption is worth accepting.
What happens if I delay, or decline this step for now? Is the decision reversible?
Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
For my situation (later lines), which of the standard options do you recommend and why?
Why: Guideline options include: Trabectedin, pazopanib, dacarbazine-based regimens, aromatase inhibitors in hormone receptor-positive low-grade uterine disease; metastasectomy for limited lung spread.
Am I a candidate for Trabectedin, Pazopanib, Letrozole (and other aromatase inhibitors), and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Add these to your appointment list, or take the full question set for this cancer.

How to read this page. Options and results come from OnCo records with their sources; the settings are the standard-of-care rows on the cancer page, and the lines of therapy are on the sequencing grid. Where a setting names one path, the choice is usually about timing, trials and where to be treated: see expert centres. OnCo is orientation, not medical advice.

Living with cancer·Standard of care

Leiomyosarcoma: the decisions you may face

Cancer page →Second-opinion finder →

Early / localised

Localised

One path named

Wide surgical resection; radiotherapy for limb and trunk tumours; no morcellation of uterine masses that could be sarcoma; adjuvant chemotherapy not standard.

The path, in plain words

IMRT / IGRT (modern external beam)Standard of care

Conformal dose, fewer side effects
Hypofractionation saves visits

The evidence behind it

No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.

The main trade-offs on record

IMRT / IGRT (modern external beam)

Low-dose bath to normal tissue
Motion management

Questions to ask about this decision

Is IMRT / IGRT (modern external beam) the only reasonable path for me, or is there a trial, a different sequence or a wait-and-see option?
Why: A single standard does not mean a single choice; timing and trials are decisions too.
What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
Why: The aim shapes how much side effect and disruption is worth accepting.
What happens if I delay, or decline this step for now? Is the decision reversible?
Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
For my situation (localised), which of the standard options do you recommend and why?
Why: Guideline options include: Wide surgical resection; radiotherapy for limb and trunk tumours; no morcellation of uterine masses that could be sarcoma; adjuvant chemotherapy not standard.

Add these to your appointment list, or take the full question set for this cancer.

Advanced, first line

Metastatic, first line

4 optionsCompare side by side →

Doxorubicin plus trabectedin (LMS-04) or doxorubicin alone; gemcitabine-docetaxel as an alternative, especially in uterine disease.

The options, in plain words

DoxorubicinApprovedCytotoxic chemotherapy (anthracycline)

The red chemotherapy drug from a soil bacterium that is still the backbone of treatment for sarcoma, lymphoma and breast cancer, limited by cumulative heart damage.

TrabectedinApprovedCytotoxic (DNA minor-groove binder)

A chemotherapy derived from a sea squirt, used with liposomal doxorubicin in relapsed ovarian cancer in Europe and for sarcomas.

GemcitabineApprovedNucleoside analogue (deoxycytidine)

A versatile chemotherapy used in pancreatic, bladder, lung, ovarian, breast and biliary cancers, in nasopharyngeal cancer, and as a bladder instillation.

DocetaxelApprovedCytotoxic chemotherapy (taxane)

The first chemotherapy to extend life in prostate cancer (2004), now part of triplet therapy at first metastatic diagnosis.

The evidence behind it

No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.

The main trade-offs on record

Doxorubicin all recorded rates →

Cumulative dose: risk rises steeply above 400-550 mg/m² (see the anthracycline calculator).
Reduce by 50% for bilirubin 20-50 µmol/L and 75% for 50-85 µmol/L.

Trabectedin all recorded rates →

Alcohol: avoid (hepatotoxicity). Dexamethasone 20 mg before each dose protects the liver.
Reduce to 0.9 mg/m² in moderate impairment; avoid in severe.

Docetaxel all recorded rates →

Do not give if bilirubin above ULN, or AST/ALT above 1.5 x ULN with alkaline phosphatase above 2.5 x ULN (treatment-related deaths).

Questions to ask about this decision

Between Doxorubicin, Trabectedin, Gemcitabine and the other options, which do you recommend for me, and what about my case would make you choose differently?
Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
Why: The aim shapes how much side effect and disruption is worth accepting.
What happens if I delay, or decline this step for now? Is the decision reversible?
Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
For my situation (metastatic, first line), which of the standard options do you recommend and why?
Why: Guideline options include: Doxorubicin plus trabectedin (LMS-04) or doxorubicin alone; gemcitabine-docetaxel as an alternative, especially in uterine disease.
Am I a candidate for Doxorubicin, Trabectedin, Gemcitabine or related drugs, and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Add these to your appointment list, or take the full question set for this cancer.

Third line and beyond

Later lines

3 optionsCompare side by side →

Trabectedin, pazopanib, dacarbazine-based regimens, aromatase inhibitors in hormone receptor-positive low-grade uterine disease; metastasectomy for limited lung spread.

The options, in plain words

TrabectedinApprovedCytotoxic (DNA minor-groove binder)

A chemotherapy derived from a sea squirt, used with liposomal doxorubicin in relapsed ovarian cancer in Europe and for sarcomas.

PazopanibApprovedSmall-molecule kinase inhibitor (VEGFR/PDGFR/KIT)

Pazopanib is the only multi-kinase inhibitor approved for soft-tissue sarcoma (excluding fat-derived tumours), used after chemotherapy fails.

Letrozole (and other aromatase inhibitors)ApprovedSmall-molecule aromatase inhibitor

Daily pills that stop the body making oestrogen after menopause, the backbone of hormone therapy for most breast cancers.

The evidence behind it

No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.

The main trade-offs on record

Trabectedin all recorded rates →

Alcohol: avoid (hepatotoxicity). Dexamethasone 20 mg before each dose protects the liver.
Reduce to 0.9 mg/m² in moderate impairment; avoid in severe.

Pazopanib all recorded rates →

Take on an empty stomach (1 hour before or 2 hours after food).
Known QT prolongation. Avoid other QT-prolonging drugs where possible; check ECG and correct potassium and magnesium before and during treatment.
200 mg daily in moderate impairment; avoid in severe.

Questions to ask about this decision

Between Trabectedin, Pazopanib and Letrozole (and other aromatase inhibitors), which do you recommend for me, and what about my case would make you choose differently?
Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?
Why: The aim shapes how much side effect and disruption is worth accepting.
What happens if I delay, or decline this step for now? Is the decision reversible?
Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
For my situation (later lines), which of the standard options do you recommend and why?
Why: Guideline options include: Trabectedin, pazopanib, dacarbazine-based regimens, aromatase inhibitors in hormone receptor-positive low-grade uterine disease; metastasectomy for limited lung spread.
Am I a candidate for Trabectedin, Pazopanib, Letrozole (and other aromatase inhibitors), and what side effects should I expect?
Why: Knowing the expected toxicities helps you plan work, family, and supportive care.

Add these to your appointment list, or take the full question set for this cancer.