We have analysed the medical records and diagnostic imaging of 76 patients presenting to this hospital for treatment of uterine sarcoma between 1970 and 1990. Patients were divided into those presenting before 1980 (n = 22) and after 1980 (n = 54), when sectional imaging (ultrasound, CT scanning) and more modern radiotherapy and chemotherapy were introduced. No survival difference was observed between these two groups. In those patients presenting after 1980, the median age was 54 years (range 18-80), and median survival 22 months from initial diagnosis. Factors associated with a significantly improved survival included low grade (although not histological type) of initial tumour (p = 0.001) and Stage I disease at presentation (p = 0.006). In 17 patients receiving pelvic radiotherapy following initial surgery, both the time to relapse (p = 0.005) and overall survival (p = 0.045) were increased. Adjuvant chemotherapy in 19 patients did not improve outcome. Most diagnoses of relapse were established clinically; they occurred most frequently in the pelvis, followed by lung and abdomen. Pulmonary relapse was accompanied by spontaneous pneumothorax in two cases. Bone and brain metastases were uncommon (< 10%). Following diagnosis of relapse, the median survival was 9 months, with the outcome significantly worse if multiple metastatic sites were involved (p < 0.001). No survival benefit was demonstrated from either local radiotherapy or combination chemotherapy once relapse had occurred. Prognostic factors and current policies for the diagnosis and management of uterine sarcomas are discussed.