When it comes to uterine leiomyosarcoma (uLMS), the best adjuvant treatment has yet to be determined. Researchers assessed the frequency with which stage II and III uLMS had adjuvant chemotherapy and radiation therapy, and they investigated whether or not such treatment was associated with improved survival. It was determined whether patients with stage II or III uLMS who were treated between 2004 and 2016 were included in the National Cancer Database. Adjuvant radiation treatment and chemotherapy use factors were estimated using multivariate regression models. An inverse probability of treatment weighted (IPTW) propensity score technique was used to examine the effect of chemotherapy on all-cause mortality, with the receipt of radiation therapy adjusting the outcome model for observed confounders. To assess radiation therapy’s effect on overall mortality, investigators once again used the IPTW propensity score approach after controlling for the use of adjuvant chemotherapy. Around 890 people were found to be patients. The percentage of patients receiving adjuvant chemotherapy rose from 62.2% in 2010 to 70.4% in 2016, whereas the percentage receiving radiation treatment fell from 26.7% in 2010 to 10.4% in 2016. Radiation therapy was less standard for patients with stage III illnesses than for those with stage II diseases. Among patients with stage III disease, those who received chemotherapy had a 30% lower risk of all-cause mortality after propensity score weighting (HR 0.70, 95% CI 0.45-0.98), but those with stage II disease saw no change in mortality (HR 0.93, 95% CI 0.70-1.20). Compared to patients without radiation therapy, those with stage II tumors had a 26% lower risk of mortality (HR 0.74; 95% CI, 0.53-0.99), and those with stage III disease had a 57% lower risk of mortality (HR 0.43; 95% CI, 0.18-0.99). Chemotherapy is being used, and radiation therapy is decreasing for women with stage II-III uLMS. There is a correlation between the use of adjuvant chemotherapy and decreased survival in stage II patients, but no correlation between the use of radiation therapy and survival in stage III patients.