Gemcitabine Hydrochloride and Docetaxel Followed by Doxorubicin Hydrochloride or Observation in Treating Patients With High-Risk Uterine Leiomyosarcoma Previously Removed by Surgery

Inclusion Criteria:

* Patients with high-risk uterine leiomyosarcoma (LMS), Federation of Gynecology and Obstetrics (FIGO) stage I (confined to corpus +/- cervix); patients with known uterine serosa involvement are not eligible; patients should have had, at least, a complete hysterectomy (including removal of the cervix); bilateral salpingo-oophorectomy is not required

  * Institutional pathology review calls the uterine leiomyosarcoma ?high grade?
  * Additionally, if the pathology report indicates a mitotic rate, the mitotic rate should be greater than or equal to 5 mitoses/10 high-power field
  * All patients must be no longer than 12 weeks (3 months) from surgical resection of cancer at the time of enrollment on study; if a patient requires a second operation to complete her surgery, i.e., trachelectomy to remove the cervix and/or bilateral salpingo-oophorectomy (BSO), the 12 weeks may be counted from the time of the second operation
  * Patients who had a ?morcellation? hysterectomy procedure that involved morcellation within the peritoneal cavity are eligible IF a second operation is performed and biopsies from the second procedure show no evidence of leiomyosarcoma
* All patients must have no evidence of persistent or metastatic disease as documented by a post-resection computed tomography (CT) of the chest/abdomen/pelvis or by CT chest + magnetic resonance imaging (MRI) abdomen/pelvis; the post-resection imaging studies should be performed within 4 weeks of registration on study
* Absolute neutrophil count (ANC) greater than or equal to 1,500/mcL (ANC \>= 1.5 x 10\^9/liter \[L\])
* Platelets greater than or equal to 100,000/mcL (platelets \>= 100 x 10\^9/L)
* Hemoglobin greater than 8.0 g/dL (= 80 g/L or 4.9 mmol/L)
* Creatinine less than or equal to 1.5 x institutional upper limit of normal (ULN)
* Bilirubin\* within normal range
* Serum glutamic oxaloacetic transaminase (SGOT) (aspartate aminotransferase \[AST\])\* and serum glutamate pyruvate transaminase (SGPT) (alanine aminotransferase \[ALT\])\* less than or equal to 2.5 times ULN
* Alkaline phosphatase\* less than or equal to 2.5 x ULN
* \* Patients with a history of Gilbert?s syndrome may be eligible provided total bilirubin is less than or equal to 1.5 x ULN and the AST, ALT, and alkaline phosphatase meet the criteria detailed
* Neuropathy (sensory and motor) less than or equal to Common Terminology Criteria for Adverse Events (CTCAE) grade 1
* Patients with Gynecologic Oncology Group (GOG) performance status of 0 or 1 OR Eastern Cooperative Oncology Group (ECOG) PS of 0 or 1 OR Karnofsky performance status (PS) \>= 80%
* Patients who have met the pre-entry requirements specified
* Patients must have signed an approved informed consent
* Patients participating through United States (U.S.) sites must sign an approved and authorization permitting release of personal health information
* Patients should be free of active infection requiring antibiotics (with the exception of an uncomplicated urinary tract infection \[UTI\])

Exclusion Criteria:

* Patients who have had prior therapy with docetaxel, gemcitabine hydrochloride, or doxorubicin hydrochloride at any time in their history
* Patients with a history of other invasive malignancies, with the exception of non-melanoma skin cancer, are ineligible if there is any evidence of other malignancy being present within the last five years; patients are also ineligible if their previous cancer treatment contraindicates this protocol therapy
* Patients with a history of severe hypersensitivity reaction to Taxotere (docetaxel) or other drugs formulated with polysorbate 80
* Patients with GOG performance status of 2, 3 or 4; or ECOG performance status of 2, 3 or 4
* Patients who are breast-feeding
* Patients with a known history of congestive heart failure or cardiac ejection fraction \< 50% (or less than institutional normal limits); echocardiogram (ECHO) or multigated acquisition scan (MUGA) is not required prior to enrollment; for patients assigned to the chemotherapy arm, an ECHO or MUGA should be done within 6 months of day 1 of gemcitabine-docetaxel treatment

  * Patients who enroll on study and are randomized to Regimen I (chemotherapy ) and then are found on baseline ECHO or MUGA to have cardiac ejection fraction \< 50% or below institutional normal will remain ON study; such patients will receive gemcitabine + docetaxel for 4 cycles but will NOT receive any doxorubicin treatment; they will continue treatment follow-up as outlined for all patients assigned to Regimen I
* Patients with a history of prior whole pelvic radiation
* Concurrent treatment with hormone replacement therapy is permitted at the discretion of the treating physician; patients who have been taking hormonal/hormone blocking agents for breast cancer or breast cancer prevention or other indication are eligible; use of anti-hormonal agents (tamoxifen, medroxyprogesterone, aromatase inhibitors) is permitted at the discretion of the treating physician; documentation of concurrent medications is required
* Patients with recurrent uterine LMS
* Patients who are known to be human immunodeficiency virus (HIV) positive are not eligible
* Patients with gross residual or metastatic tumor findings following complete surgical treatment for uterine LMS