CytoreductiveSurgery & HIPEC w/Gemcitabine+Chemotherapy w/Dacarbazine in Uterine Leiomyosarcoma

Inclusion Criteria:

   1. Histologically confirmed diagnosis of uterine leiomyosarcoma (LMS) with evidence of
   local recurrence.

   2. Imaging provides evidence of locally recurrent uterine LMS.

   3. Candidate for potentially radical, maximal effort cytoreductive surgery at the
   discretion and expertise of the treating physician.

   4. Age ≥ 18 years.

   5. Life expectancy > 3 months.

   6. Women of childbearing potential (WOCBP) will have a negative pregnancy test ≤ 7 days
   prior to surgery (this test can be omitted if subject is post menopausal by either
   surgery or elevated FSH)

   7. Eastern Cooperative Oncology Group (ECOG) Performance Status ≤ 2.

   8. Hemoglobin (HGB) ≥ 9 g/dL.

   9. White blood cell count (WBC) ≥ 3.0 K/ul.

10. Absolute neutrophil count (ANC) ≥ 1.5 K/ul.

11. Platelets (PLT) ≥ 100 K/ul.

12. Total bilirubin within normal institutional limits.

13. Serum glutamic oxaloacetic transaminase (SGOT/Serum glutamic pyruvic transaminase
   (SGPT) < 2.5 x institutional upper limit of normal (ULN).

14. Creatinine < 1.5 x ULN or creatinine clearance > 60 mL/min according to Cockroft Gault
   formula.

15. Prothrombin Time (PT) such that international normalized ratio (INR) is < 1.5 (or an
   in range INR, usually between 2 and 3, if a subject is on a stable dose of therapeutic
   warfarin or low molecular weight heparin) and a partial thromboplastin time (PTT) <
   1.2 times control.

16. Serum albumin ≥ 2.5 g/dL.

17. Ability to understand and the willingness to personally sign the written IRB approved
   informed consent document.

Note that this study does not allow the use of a legally authorized representative

Exclusion Criteria:

   1. Recurrence of LMS within less than 6 months after the last dose of gemcitabine.

   2. Active extra abdominal disease including active malignant pleural effusion. Subjects
   who have been successfully treated with neoadjuvant chemotherapy and no longer have
   (malignant) pleural effusions may be included.

   3. Prior gemcitabine given in non adjuvant setting.

   4. Prior treatment with dacarbazine.

   5. Active infection requiring antibiotics.

   6. Unresolved toxic effects of prior therapy (except alopecia). Resolution is considered
   ≤ Grade 1 per NCI CTCAE, version 5.0.

   7. Pregnant.

   8. Breast feeding.

   9. Presence of metastatic liver disease