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NCCN Soft-Tissue Extremity Sarcoma Guidelines Clarify Follow-up Schedule

NCCN Soft-Tissue Extremity Sarcoma Guidelines Clarify Follow-up Schedule

HOLLYWOOD, Florida—Drs. Ephraim S. Casper, Memorial Sloan-Kettering Cancer Center, and George D. Demetri, Dana-Farber Cancer Institute, discussed the 2006 National Comprehensive Cancer Network (NCCN) guidelines on soft-tissue sarcomas at the NCCN 11th Annual Conference. The updated guidelines clarify the follow-up schedule for patients with extremity sarcoma.

In sarcomas of the extremities, local recurrence is seen in less than 20% of cases, and the lung is the first site of metastasis in more than 90% of cases. In retroperitoneal sarcoma, local recurrence is a major cause of morbidity, "so local control is a major focus of therapy," Dr. Casper said.

Adjuvant chemotherapy for stage I, T2a-b, N0, M0 low-grade extremity sarcomas is now classified as category 3 (formerly it had been category 2b), Dr. Casper said. Category 2B indicates nonuniform consensus but no major disagreement on the recommendation, whereas category 3 indicates substantial disagreement within the panel. "Some thought that it was indicated, whereas others thought
it was contraindicated. Thus, its use is highly controversial," he commented.

Adjuvant chemotherapy in stage II and III disease also remains controversial, but less so than for stage I, Dr. Casper said, since such therapy is associated with improved disease-free survival, even if it is not associated with a statistically significant advantage in overall survival.

With unresectable or marginally resectable extremity soft-tissue sarcomas, the goal is to shrink the tumor enough to make it resectable. "Chemotherapy, radiotherapy, and chemoradiotherapy are all effective, and no one modality has yet been shown to be better than the others," Dr. Casper said.

Combination chemotherapy for soft-tissue sarcomas produces higher response rates than single-agent therapy, but needs to be used selectively, Dr. Casper said, since it is associated with greater morbidity than sequential single-agent therapy. "The goal of therapy in this setting generally is palliative," he said.

Other recommendations from the 2006 NCCN guidelines for extremity sarcomas include: Imaging of the primary mass for all lesions that have a reasonable chance of being malignant.

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