Evidence:
The analysis of the IRS-I to -IV trials showed a trend towards less aggressive surgical approaches from pelvic exenteration in IRS-I towards preservation of a functional genitourinary tract. Therefore, surgical guidelines tended to delay radical surgery in order to avoid it whenever possible. However, in cases in which intensive chemotherapy with or without RT could not eradicate the tumor, radical surgery was used.9 In the pooled international analysis definitive local control was achieved in 70% of uterus RMS, and 7 of 12 patients had hysterectomy as primary surgery.4