What are the guideline sources, guidelines and references for Soft tissue sarcoma ?
Guideline sources The following summarized guidelines for the evaluation and management of soft tissue sarcoma (STS) are prepared by our editorial team based on guidelines from the American Society for Radiation Oncology (ASTRO 2021) and the European Society of Medical Oncology (ESMO 2018). 1 3 Calculator Calculator Eastern Cooperative Oncology G Karnofsky performance status s Guidelines 1. Medical management General principles: As per ASTRO 2021 guidelines: Obtain expert pathology and radiology review and multidisciplinary evaluation before initiating treatment in patients with localized STS. B https://web.pathway.md/diseases/rect28u4cjpxJV9IZ 1/3 6/24/23, 3:14 PM Soft tissue sarcoma Pathway Determine the sequencing of surgery and radiotherapy in patients with primary, localized extremity and truncal STS based on multidisciplinary evaluation of patient and tumor characteristics. B As per ESMO 2018 guidelines, manage patients with STS in reference centers for sarcomas. Show 2 more Neoadjuvant chemotherapy: consider offering neoadjuvant chemotherapy with anthracyclines plus ifosfamide for at least 3 cycles in high-risk patients with localized STS. C Adjuvant chemotherapy: avoid offering adjuvant chemotherapy as standard treatment in patients with adult-type STS. Consider offering it in high-risk patients with localized STS. D Definitive chemotherapy: offer anthracyclines as first-line therapy for definitive chemotherapy in patients with advanced STS. A Show 10 more 2. Therapeutic procedures Neoadjuvant radiotherapy: offer neoadjuvant radiotherapy in patients with primary, localized extremity and truncal STS at increased risk for local recurrence, planned to undergo oncologic resection. A Show 4 more Adjuvant radiotherapy: As per ASTRO 2021 guidelines, offer postoperative radiotherapy in patients with primary, localized extremity and truncal STS treated with initial oncologic resection (without preoperative radiotherapy) found to have unanticipated adverse pathologic features. B Show 2 more As per ESMO 2018 guidelines: Offer adjuvant radiotherapy following wide excision as the standard treatment in patients with high-grade (G2-3), deep, > 5 cm lesions. B Consider making exceptions after multidisciplinary discussion taking into account several variables. Technical considerations for radiotherapy: use 5,000 cGy in 25 once daily fractions for preoperative radiotherapy in patients with primary, localized extremity and truncal STS. B Show 5 more 3. Surgical interventions Wide-local excision: As per ASTRO 2021 guidelines, perform oncologic resection, when feasible, in patients with primary, localized extremity and truncal STS undergone an unplanned excision. B https://web.pathway.md/diseases/rect28u4cjpxJV9IZ 2/3 6/24/23, 3:14 PM Soft tissue sarcoma Pathway As per ESMO 2018 guidelines, perform wide excision with negative margins (absence of residual tumor, R0) as the standard treatment in patients with an adult-type, localized STS, performed by a surgeon specifically trained in the treatment of this disease. B 4. Specific circumstances Patients with lung metastasis: perform surgical resection as standard treatment of metachronous (disease-free interval 1 year), resectable lung metastases without extrapulmonary disease, if complete excision of all lesions is feasible. B Patients with desmoid-type fibromatosis: Individualize the management of patients with progressing desmoid-type fibromatosis, consisting of: watchful waiting surgery isolated limb perfusion (if the lesion is confined to an extremity) systemic therapies percutaneous cryoablation. B References 1. Casali PG, Abecassis N, Aro HT et al. Soft tissue and visceral sarcomas: ESMO EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2018 Oct 1;29 Suppl 4):iv51-iv67. Open 2. von Mehren M, Randall RL, Benjamin RS et al. Soft Tissue Sarcoma, Version 2.2018, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2018 May;16 5 536 563. Open 3. Kilian E Salerno, Kaled M Alektiar, Elizabeth H Baldini et al. Radiation Therapy for Treatment of Soft Tissue Sarcoma in Adults: Executive Summary of an ASTRO Clinical Practice Guideline. Pract Radiat Oncol. Sep-Oct 2021;11 5 339 351. Open 4. von Mehren M, Randall RL, Benjamin RS et al. Soft Tissue Sarcoma, Version 2.2018, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2018 May;16 5 536 563. Open 5. Casali PG, Abecassis N, Aro HT et al. Soft tissue and visceral sarcomas: ESMO EURACAN Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2018 Oct 1;29 Suppl 4):iv268-iv269. Open 6. A L pez-Pousa, J Martin Broto, J Martinez Trufero et al. SEOM Clinical Guideline of management of soft- tissue sarcoma 2016 . Clin Transl Oncol. 2016 Dec;18 12 1213 1220. Open https://web.pathway.md/diseases/rect28u4cjpxJV9IZ 3/3