Clinical practice guidelines in sarcoma in Scandinavia

On behalf of the Scandinavian Sarcoma Group (SSG)

Kirsten Sundby Hall

                    

                 

Clinical guidelines

SSG tradition: Current protocols define standard treatment in Scandinavia

• Clinical trials • Treatment recommendations:

SSG XVII, SSG XIX • Registration : SSG VII , SSG XVI

1986 – 2004: 6 908 patientsAll sarcoma centers in Sweden (5) and Norway (3) register patients, Finland 1 Population based for Norway and Sweden.

Referral pattern, treatment, prognosis

www.ssg-org.net

SSG Registry

Guidelines for referral of soft-tissue

tumors to tumor center

• Deep tumors of any size

• Subcutaneous tumors size > 5cm

• All other tumors supected of being malignant

Referral before biopsy %

1986-89 58

1990-94 58

1995-99 63

2000-03 73

Referral before biopsy %

Sc Deep

1986-89 36 77

1990-94 43 78

1995-99 42 84

2000-03 58 93

Improvement for both sc and deep located tumors!

Biopsy method before surgical treatment %

NoneCytology

FNATrue-cut

Open

1986-99 9 73 4 142000-03 3 64 28 5

More than 1 type of biopsy: from 1% to 15%

Smeland, Stuttgart 2005

Increased use of radiotherapy %

All Sc Deep

1986-99 21 11 24

2000-03 33 24 44

Guidelines for referral of bone lesions to tumor center

• Lesions that can simulate bone tumors

osteosarcoma GCT GCT with ABC

Referral before biopsy (bone lesions) %

All bone

1986-92 81

1993-03 88

Biopsy method (bone lesions) %

None CytologyTrue-cut

Open

1986-92 11 14 20 55

1993-03 5 36 24 35

More than 1 type of biopsy: from 8% to 13%

Guidelines for treatment of metastatic

soft-tissue sarcomas in adult patients

Proposals for treatment

• With a curative intent

• With a palliative intent

• Chemotherapy-Surgery-Radiotherapy

Guidelines for treatment of abdominal sarcomas

• Preoperative diagnosis and planning

• Surgery

• Chemotherapy, radiotherapy

• Follow-up

• Centralized management !

Concluding statement

Guidelines for clinical practice should be

• continuously evaluated and revised according to register data

• subject to increasing international collaboration